title: Laparoscopic treatment of pheochromocytomas smaller or larger than 6 cm. A clinical retrospective study on 44 patients. Laparoscopic adrenalectomy for pheochromocytoma.
abstract: BACKGROUND
  Laparoscopic adrenalectomy is a gold standard for the treatment of pheochromocytomas less than 6 cm in diameter. Given the difficulty in dissecting the adrenal glands, the presumed increase in the risk of malignancy, and capsular disruption there is controversy regarding minimally invasive surgery for neoplasms greater than 6 cm. The aim of this study was to report laparoscopic adrenalectomy results in 44 patients with pheochromocytomas either larger or smaller than 6 cm.
  
  
  METHODS
  The retrospective clinical study was conducted on 44 patients who underwent surgery in the Campania region in Italy, between January 1998 and January 2008. In 30 cases the lesion measured ≤ 6 cm (group A) in diameter and in 15 > 6 cm (group B). The authors compared cardiovascular instability, operative time, conversion rate, incidence of intra and postoperative complications, length of hospital stay, and medium long term follow-up results in the two groups of patients.
  
  
  RESULTS
  By comparing group A vs group B no significant differences were observed in operative time, incidence of intra and postoperative complications length of hospital stay or medium long term follow-up results. In patients with pheochromocytomas > 6 cm a higher conversion rate, although not statistically significant, was observed. The same occurred with cardiovascular instability shown by intraoperative sudden bouts of hypertension. One patient underwent "open" reoperation for residual retrocaval glandular tissue, not removed during laparoscopic treatment.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy for pheochromocytoma by experienced laparoscopic surgeon is safe and probably preferable also in selected cases larger than 6 cm. These patients may have a longer operative time, a greater intraoperative blood loss, a higher conversion rate, more intraoperative hypertensive crises than other patients. Adequate preoperative pharmacological therapy and careful anaesthesia monitoring make possible optimal management of cardiovascular instability.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.forename: Francesco
authors.initials: F
authors.lastname: Corcione
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Palma
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.forename: Marco
authors.initials: M
authors.lastname: Milone
authors.forename: Cristina
authors.initials: C
authors.lastname: Della Pietra
authors.forename: Antonietta
authors.initials: A
authors.lastname: Palazzo
authors.forename: Domenico
authors.initials: D
authors.lastname: Parmeggiani
authors.forename: Daniela
authors.initials: D
authors.lastname: Pasquali
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Sinisi
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult