Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma.
BACKGROUND
Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors.


METHODS
A prospective randomized study was conducted (2000-2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring.


RESULTS
Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 +/- 94 cc versus 48 +/- 36 cc, p < 0.05) and operative time (180 +/- 40 versus 158 +/- 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p < 0.05). Long-term follow-up was always normal.


CONCLUSIONS
Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.
Tiberio
Guido A M
GA
Surgical Clinic, Department of Medical and Surgical Sciences, University of Brescia, 25100, Brescia, Italy. guido.tiberio@libero.it
Baiocchi
Gian Luca
GL
Arru
Luca
L
Agabiti Rosei
Claudia
C
De Ponti
Simona
S
Matheis
Albert
A
Rizzoni
Damiano
D
Giulini
Stefano M
SM
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010673:Pheochromocytoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D002245:Carbon Dioxide