[Minimally invasive adrenalectomy for pheochromocytoma: routine or risk?].
BACKGROUND
As a result of intraoperative catecholamine secretion with hemodynamic changes, larger tumor size, and marked neovascularization, adrenalectomy is more challenging and prone to complications for pheochromocytoma than for other adrenal diseases. The aim of this study was to examine the relative intraoperative risk of cardiovascular complications with the minimally invasive approach.


METHODS
Between February 1992 and May 2005, 82 operations were performed on 71 pheochromocytoma patients at our clinic. Of them, nine adrenalectomies were bilateral, one was trilateral, and two patients had recurrent procedures. Another five patients were included whose first operations took place before 1992. Thirty-six procedures were carried out conventionally (35 transperitoneally, one retroperitoneally) and 46 were endoscopic (28 transperitoneally, 18 retroperitoneally). There was no conversion to open procedure.


RESULTS
The median age at the time of surgery was 45 (24-75) years, and the median history of symptoms was 12 months (0-180). The openly resected pheochromocytomas were significantly larger than those in endoscopic operations: 5.5 cm (1-19 cm) vs 3.5 cm (0.5-8 cm) (P=0.0011). Compared with patients undergoing conventional procedures, those operated on endoscopically showed higher intraoperative systolic and diastolic blood pressures and peaks of more than 200 mmHg, although these differences were statistically insignificant. Multivariate analysis identified gender (P=0.0107), operative approach (P=0.0153), age (P=0.0364), and tumor size (P=0.0484) as factors with a possible influence on intraoperative hemodynamic alterations. Postoperative hospital stay was significantly shorter following endoscopic adrenalectomy (P=0.0001).


CONCLUSIONS
Endoscopic adrenalectomy for pheochromocytoma is suitable as a routine operation and harbors no increased risk of cardiovascular complications, making it the method of choice. The open procedure should be reserved for extraadrenal tumors or large tumors with the suspicion of malignancy.
Gockel
I
I
Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz. gockel@ach.klinik.uni-mainz.de
Heintz
A
A
Roth
W
W
Junginger
T
T
D000310:Adrenal Gland Neoplasms / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D004724:Endoscopy; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000503:physiopathology / Q000601:surgery; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012187:Retroperitoneal Space