Laparoscopic and Retroperitoneoscopic Treatment of Pheochromocytomas and Retroperitoneal Paragangliomas: Results of 161 Tumors in 126 Patients View Full Text


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Article Info

DATE

2006-03-17

AUTHORS

Martin K. Walz, Piero F. Alesina, Frank A. Wenger, J. Albrecht Koch, Hartmut P. H. Neumann, Stephan Petersenn, Kurt W. Schmid, Klaus Mann

ABSTRACT

BackgroundLaparoscopic and retroperitoneoscopic excisions of pheochromocytomas and retroperitoneal paragangliomas are challenging surgical procedures because of extensive intraoperative catecholamine release, extreme vascularization, and demanding localization.MaterialsIn a prospective clinical study 161 chromaffine neoplasias (134 pheochromocytomas, 27 paragangliomas) were removed endoscopically in 126 patients (67 males, 59 females, age 41.7 ± 16.4 years; 130 operations). Six patients showed multiple (2–5) tumors. Tumor size ranged from 0.5 to 12 cm (mean 3.5 ± 1.9 cm). Forty-two patients suffered from hereditary diseases. Twenty-four patients had bilateral adrenal diseases; in 14 patients pheochromocytomas were removed on both sides synchroneously. Ten neoplasias were local or loco-regional recurrences (7 pheochromocytomas, 3 paragangliomas). The laparoscopic route was chosen in 16 operations; the retroperitoneoscopic technique was performed in 128 others. Partial adrenalectomies were performed in 57 operations (in all but one of the patients with bilateral disease). High-dosage α-blockade with phenoxybenzamine was routinely used.Results and DiscussionConversion to open surgery occurred once. Perioperative complications were minor (17%); mortality was zero. Operating time for unilateral retroperitoneoscopically removed primary pheochromocytomas (n = 113) was 82 ± 49 minutes (range: 20–300 minutes) and depended on tumor size (< 3 cm vs. ≥ 3 cm; P < 0.05) and gender (P < 0.001), but not on extent of resection (partial vs. total, P = 0.266). Operating time for paragangliomas ranged from 55 to 600 minutes. Median blood loss was 20 ml. Median duration of postoperative hospitalization was 4 days. In 22 of 24 patients with bilateral disease, complete preservation of cortical function was achieved. Locoregional and/or distant metastatic recurrence were found in 5 patients.ConclusionsEndoscopic removal of solitary, bilateral, multiple, and recurrent pheochromocytomas and retroperitoneal paragangliomas is feasible and safe, but surgeons need extensive experience in minimally invasive techniques, as well as in endocrine surgery. More... »

PAGES

899-908

References to SciGraph publications

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  • 1998-06. Subtotal Adrenalectomy by the Posterior Retroperitoneoscopic Approach in WORLD JOURNAL OF SURGERY
  • 2003-07. Subtotale bilaterale Adrenalektomie mit adrenokortikalem Funktionserhalt in DER CHIRURG
  • 2002-06-06. Endoscopic Treatment of Solitary, Bilateral, Multiple, and Recurrent Pheochromocytomas and Paragangliomas in WORLD JOURNAL OF SURGERY
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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00268-005-0373-6

    DOI

    http://dx.doi.org/10.1007/s00268-005-0373-6

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1039447226

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/16617419


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    34 schema:description BackgroundLaparoscopic and retroperitoneoscopic excisions of pheochromocytomas and retroperitoneal paragangliomas are challenging surgical procedures because of extensive intraoperative catecholamine release, extreme vascularization, and demanding localization.MaterialsIn a prospective clinical study 161 chromaffine neoplasias (134 pheochromocytomas, 27 paragangliomas) were removed endoscopically in 126 patients (67 males, 59 females, age 41.7 ± 16.4 years; 130 operations). Six patients showed multiple (2–5) tumors. Tumor size ranged from 0.5 to 12 cm (mean 3.5 ± 1.9 cm). Forty-two patients suffered from hereditary diseases. Twenty-four patients had bilateral adrenal diseases; in 14 patients pheochromocytomas were removed on both sides synchroneously. Ten neoplasias were local or loco-regional recurrences (7 pheochromocytomas, 3 paragangliomas). The laparoscopic route was chosen in 16 operations; the retroperitoneoscopic technique was performed in 128 others. Partial adrenalectomies were performed in 57 operations (in all but one of the patients with bilateral disease). High-dosage α-blockade with phenoxybenzamine was routinely used.Results and DiscussionConversion to open surgery occurred once. Perioperative complications were minor (17%); mortality was zero. Operating time for unilateral retroperitoneoscopically removed primary pheochromocytomas (n = 113) was 82 ± 49 minutes (range: 20–300 minutes) and depended on tumor size (< 3 cm vs. ≥ 3 cm; P < 0.05) and gender (P < 0.001), but not on extent of resection (partial vs. total, P = 0.266). Operating time for paragangliomas ranged from 55 to 600 minutes. Median blood loss was 20 ml. Median duration of postoperative hospitalization was 4 days. In 22 of 24 patients with bilateral disease, complete preservation of cortical function was achieved. Locoregional and/or distant metastatic recurrence were found in 5 patients.ConclusionsEndoscopic removal of solitary, bilateral, multiple, and recurrent pheochromocytomas and retroperitoneal paragangliomas is feasible and safe, but surgeons need extensive experience in minimally invasive techniques, as well as in endocrine surgery.
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