title: Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment?
abstract: BACKGROUND
  Laparoscopic adrenalectomy has become the gold standard for removing adrenal masses, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. The purpose of this study was to evaluate the short- and long-term outcomes of laparoscopic versus open adrenalectomy for pheochromocytomas and to compare the feasibility and safety of laparoscopic adrenalectomy for neoplasms that are smaller than 6 cm versus those that are larger than 6 cm.
  
  
  METHODS
  From January 1990 to December 2005, the same team in our department carried out 221 adrenalectomies in 211 patients. A total of 64 of these patients underwent 71 adrenalectomies for pheochromocytoma, 24 patients (37%) had open adrenalectomy, and 40 patients (63%) had laparoscopic adrenalectomy. Sex, age, side and size of lesion, operating time, duration of hospital stay, need for intensive care, intraoperative blood pressure variations, blood loss, postoperative analgesia, return to oral nutrition, and complications were compared among groups.
  
  
  RESULTS
  An advantage of laparoscopic adrenalectomy over open adrenalectomy was observed in mean operating time, hospital stay, need for intensive care, intraoperative hypertension, intraoperative blood loss, postoperative analgesia, and return to oral nutrition (P <or= .035 in all). The analysis of tumor size (<or=6 vs >6 cm) in laparoscopic adrenalectomy showed that none of the variables differed significantly, except for intraoperative blood loss, which was greater for the larger neoplasms (P = .007).
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy, when performed by experienced laparoscopic surgeons, is preferable to open adrenalectomy for the majority of pheochromocytomas, and as long as there is no evidence of invasion of surrounding structures, tumor size does not appear to have a profound effect on surgical outcome.
authors.affiliation: Institute of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua School of Medicine, Italy. giorgiolina@libero.it <giorgiolina@libero.it>
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniato
authors.forename: Isabella Merante
authors.initials: IM
authors.lastname: Boschin
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Opocher
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guolo
authors.forename: Mariarosa
authors.initials: M
authors.lastname: Pelizzo
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000698:Analgesia; D016063:Blood Loss, Surgical; D003422:Critical Care; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D011182:Postoperative Care; D013997:Time Factors