title: Pheochromocytoma does not increase risk in laparoscopic adrenalectomy.
abstract: BACKGROUND
  Laparoscopic adrenalectomy (LA) has become the standard approach to an adrenal mass. This technique provides for decreased convalescence, less postoperative pain, and improved cosmesis. The use of LA for pheochromocytoma (PHE) has been questioned due to concerns of increased morbidity and negative hemodynamic sequelae. This study aimed to compare the outcomes of LA for PHE with the results of LA for other adrenal pathologies.
  
  
  METHODS
  A retrospective chart review was performed for an 11-year period from July 1997 to December 2008. Patient demographics, perioperative data, and outcomes were recorded. Statistical analysis was performed using SPSS 16.0. Statistical significance was defined as a p value less than 0.05.
  
  
  RESULTS
  A total of 102 LA procedures were completed for 95 patients. The data for 33 PHE cases were compared with the data for 69 non-PHE cases (26 adenomas, 14 aldosteronomas, 5 cortisol-secreting tumors, 5 multinodular hyperplasias, and 19 other disorders). Five LA procedures were converted to open surgery. Four of these conversions involved patients with PHE (p = 0.03). There was no difference in the mean estimated blood loss (p = 0.2) or operative time (p = 0.1) between the two groups. The frequency of intraoperative hypertension and hypotension did not differ between the PHE and non-PHE cohorts. The complication rate was 7.5% for the PHE group and 6.9% for the non-PHE group (p = 0.7). The patients with PHE had a longer postoperative hospital stay (3.6 vs 2.3 days; p < 0.001) and overall hospital stay (4.9 vs 2.6 days; p < 0.001). Time in the intensive care unit (1.1 vs 0.1 days; p < 0.001) and time until oral intake (1.5 vs 1.0 days; p = 0.02) also were increased in the PHE population. There was one death in the PHE group secondary to congestive heart failure.
  
  
  CONCLUSIONS
  Concerns of increased morbidity related to a laparoscopic approach for patients with a diagnosis of PHE are unfounded. In this series, the only disparity in outcomes between the two groups was an increased conversion rate with PHE.
authors.affiliation: Center for Minimally Invasive Surgery, Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH 43210-1228, USA. peter.nau@osumc.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Nau
authors.forename: Sebastian
authors.initials: S
authors.lastname: Demyttenaere
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.forename: Vimal
authors.initials: V
authors.lastname: Narula
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications