title: Metastases but not cardiovascular mortality reduces life expectancy following surgical resection of apparently benign pheochromocytoma.
abstract: The treatment of choice for non-metastatic pheochromocytoma is surgical resection. Its goals are to abolish catecholamine hypersecretion, normalize blood pressure, and prevent further tumor growth or progression to metastatic disease. Data on long-term mortality and morbidity after pheochromocytoma surgery are limited. We here report a retrospective study on the long-term outcome after surgery for apparently benign pheochromocytoma at the Radboud University Nijmegen Medical Centre. Data on clinical presentation, treatment, post-surgical blood pressure and recurrence, metastasis and death were collected of 69 consecutive patients (January 1966-December 2000; follow-up: until death or January 2006). Survival was compared with survival of a matched reference population. Two patients died of surgical complications. All ten patients with metastatic disease (including three diagnosed at first surgery) died. At follow-up, 40 patients were alive and recurrence free and three patients were lost to follow up. Two patients experienced a benign recurrence. Mean+/-s.d. follow-up was 10.2+/-7.5 (median 9, range 1-38) years. Kaplan-Meier estimates for 5- and 10-year survival since surgery were 85.8% (95% CI: 77.2-94.4%) and 74.2% (95% CI: 62.0-86.4%) for patients versus 95.5 and 89.4% in the reference population (P<0.05). Sixty-four percent of all patients with hypertension prior to surgery showed a significant decrease in blood pressure, but remained hypertensive after surgery. In conclusion, compared with the general population patients have a reduced life expectancy following pheochromocytoma surgery, due to their risk of developing metastatic disease. Only one-third becomes normotensive without antihypertensive medication. Therefore, lifelong follow-up is warranted.
authors.affiliation: Department of Endocrinology (741), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. h.timmers@endo.umcn.nl
authors.forename: H J L M
authors.initials: HJ
authors.lastname: Timmers
authors.forename: F M
authors.initials: FM
authors.lastname: Brouwers
authors.forename: A R M M
authors.initials: AR
authors.lastname: Hermus
authors.forename: F C G J
authors.initials: FC
authors.lastname: Sweep
authors.forename: A A J
authors.initials: AA
authors.lastname: Verhofstad
authors.forename: A L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: K
authors.initials: K
authors.lastname: Pacak
authors.forename: J W M
authors.initials: JW
authors.lastname: Lenders
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002395:Catecholamines / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D010673:Pheochromocytoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002395:Catecholamines