title: Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series.
abstract: BACKGROUND
  Minimally invasive adrenalectomy for pheochromocytoma (PCC) is a complex surgical procedure especially because of the haemodynamic instability due to the excessive secretion of cathecolamines, which may result in a considerable risk of conversion and complications.
  
  
  OBJECTIVE
  By a multicentric retrospective study, the authors reported the results of laparoscopic adrenalectomies in patients operated for adrenal pheochromocytomas with the aim of investigating the role of the laparoscopic approach in managing adrenal disease.
  
  
  METHODS
  Sixty patients, preoperatively treated with a selective alpha1-blocker, underwent 61 laparoscopic adrenalectomies for PCC smaller or larger than 6 cm - group A (≤6 cm), group B (>6 cm). We compared the two groups of patients analyzing haemodynamic instability, operative time, conversion rate, incidence of complications, length of hospital stay and medium and long-term outcomes.
  
  
  RESULTS
  In 23 cases tumor was >6 cm in diameter. Average operative time was 165 min, with a 5% conversion rate. There was no mortality and morbidity rate was 8.3%. Intraoperative hypertensive crises were registered in 15% of patients, whereas 5/60 patients had hypotensive crises. After comparing the two groups of patients, no statistically significant differences in terms of haemodynamic instability, operative time, conversion rate, morbidity and length of hospital stay were observed.
  
  
  CONCLUSIONS
  As a surgical treatment of pheochromocytomas, laparoscopic adrenalectomy is an effective and safe approach, in selected cases even for PCCs >6 cm in diameter, although patients with such large tumors may have a higher conversion rate and more intraoperative hypertensive crises. Preoperative selective adrenergic blockade does not prevent intraoperative hypertensive crises, but by facilitating the pharmacological management of the perioperative haemodynamic instability, may avoid the onset of major adverse cardiovascular complications.
authors.affiliation: Department of Anaesthesiology, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Gen. Giordano Orsini 42, 80132 Naples, Italy. giovanni.conzo@unina2.it
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: Fausto
authors.initials: F
authors.lastname: Ferraro
authors.forename: Antonietta
authors.initials: A
authors.lastname: Palazzo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Napolitano
authors.forename: Marco
authors.initials: M
authors.lastname: Milone
authors.forename: Daniela
authors.initials: D
authors.lastname: Pasquali
authors.forename: Antonio Agostino
authors.initials: AA
authors.lastname: Sinisi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colantuoni
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000008:administration & dosage; D000328:Adult; D017292:Doxazosin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D017292:Doxazosin