title: Surgical management of organ-contained unilateral pheochromocytoma: comparative outcomes of laparoscopic and conventional open surgical procedures in a large single-institution series.
abstract: OBJECTIVE
  Laparoscopic excision is preferred for small non-invasive pheochromocytoma over open approach. Applicability of laparoscopic procedures for large organ-contained pheochromocytoma is unclear. A database of 137 pheochromocytoma patients managed during 1990-2010 was reviewed to compare outcomes of open and laparoscopic procedures for 101 unilateral organ-contained pheochromocytoma patients in this retrospective non-randomized study.
  
  
  METHODS
  Forty-nine patients underwent open procedures, and 52 underwent laparoscopic procedures. Laparoscopic procedure was converted to open in 19 due to bleeding (n = 12), concern for malignancy (n = 5), hypertensive crisis (n = 1), and equipment failure (n = 1). Outcome measures were compared between open, laparoscopic, and conversion patient groups.
  
  
  RESULTS
  Patient groups were well matched for age, gender, BMI, and clinical and pathological characteristics. Mean tumor size was insignificantly larger in the open (7.6 ± 2.7 cm) than the laparoscopic group (6.6 ± 2 cm, p = 0.06). There were no significant differences in periop hemodynamic events. Mean blood loss, blood transfusion and analgesic requirements, and postop ICU and hospital stay were significantly lesser in laparoscopic than open and conversion groups (p < 0.05). There was no periop mortality. Morbidity occurred more frequently in the open (n = 12) than in the laparoscopic group (n = 3). At follow-up (mean, 44 ± 33.7; range, 6-160 months), no patient had recurrent pheochromocytoma. Outcomes in terms of cure of pheochromocytoma and hypertension were not different between the three groups.
  
  
  CONCLUSIONS
  Laparoscopic procedures are feasible and as safe and effective as open procedures for patients with organ-contained pheochromocytoma. In a patient cohort where majority of the patients had large (>6 cm) pheochromocytoma, laparoscopic procedures resulted in lesser morbidity and shorter convalescence and provided equal chance for cure of pheochromocytoma and hypertension as conventional open surgical procedures.
authors: Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India. gaurav@sgpgi.ac.in
authors: Gaurav
authors: G
authors: Agarwal
authors: Dhalapathy
authors: D
authors: Sadacharan
authors: Vivek
authors: V
authors: Aggarwal
authors: Gyan
authors: G
authors: Chand
authors: Anjali
authors: A
authors: Mishra
authors: Amit
authors: A
authors: Agarwal
authors: Ashok K
authors: AK
authors: Verma
authors: Saroj K
authors: SK
authors: Mishra
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome