Results of minimally invasive surgery for pheocromocitoma:a policentric retrospective study of 44 patients.

Background Pheochromocytoma is a rare neuroendocrine tumor which mostly involves the adrenal glands and in only 10% of cases originates in extra-adrenal chromaffin tissue. Laparoscopic adrenalectomy (LA) is the gold standard for surgical treatment of tumors up to 6 cm in diameter and weighing less than 100 g. However, the role of laparoscopy in the treatment of lesions over 6 cm in diameter is still controversial, especially as regards pheochromocytomas. Purpose The aim of this study is to report the results of a polycentric retrospective study of 44 patients with pheochromocytoma conducted between January 1998 and June 2009. Methods Between January 1998 and June 2009, 44 patients, 29 women and 15 men, with an average age of 45 years (range: 21-77), who suffered from pheochromocytoma, underwent LA after preoperative preparation with an alpha adrenergic receptor blocker, for at least 2 weeks. All procedures were performed under general anesthesia and the patients underwent intra-arterial pressure monitoring. Results The average operative time was 177 minutes (range: 90-300). In 2 cases (4.5%) conversion to open was necessary; in one due to the presence of adherential syndrome, and in the other due to suspected invasion of the renal vessels, which was not confirmed on the definitive histological exam. There was no mortality. Four patients (9%) had complications. There was one case of hemorrhage, which resolved intraoperatively, one case of delayed wound healing in a diabetic patient, one case of serosanguineous fluid collection in the periadrenal space and high fever, treated with ultrasound- guided percutaneous drainage, and one case of pneumothorax, cured by pleural drainage. Sixteen patients (36.4%) had hypertensive crises, and 4 (9%) had hypotensive crises, which resolved after medical therapy. The average length of hospital stay was 4.5 days (range: 3-8). Follow-up involved arterial blood pressure monitoring, measurement of urinary metanephrines every 6 months, and imaging studies only in patients with hypertension and/or elevated levels of metanephrines. One patient had to be reoperated on because of disease persistence and underwent open surgery via a posterior approach. There were no significant long-term complications. Conclusions For patients with pheochromocytoma LA is effective, safe, and chartacterized by low morbidity. Adequate preoperative treatment with an alpha adrenergic receptor blocker does not prevent hypertensive rises but facilitates management of cardiovascular instability. However, minimally invasive surgery for pheochromocytoma is a complex procedure and should therefore be performed by dedicated and experienced multidisciplinary teams in specialized centers