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Gan L, Peng L, Meng C, Zheng L, Zeng Z, Ge S, Wang Z, Li K, Li Y. The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (>6 cm): a meta-analysis and systematic review. Int J Surg 2023; 109:1459-1469. [PMID: 37037515 PMCID: PMC10389469 DOI: 10.1097/js9.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown. MATERIALS AND METHODS This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6 cm in diameter), LARGE group (>6 cm in diameter). RESULTS Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT weighted mean difference (WMD)=32.55; 95% CI: 11.17, 53.92; P <0.01], length of stay (LOS WMD=0.82; 95% CI: 0.19, 1.44; P <0.05), more estimated blood loss (EBL WMD=85.26; 95% CI: 20.71, 149.82; P <0.05), hypertension [odds ratio (OR)=3.99; 95% CI: 1.84, 8.65; P <0.01], hypotension (OR=1.84; 95% CI: 1.11, 3.05; P <0.05), and conversion (OR=5.60; 95% CI: 1.56, 20.13; P <0.01). In the transabdominal LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA group, complications and hypotension were the same in both groups, while the LARGE group had longer OT (WMD=52.07; 95% CI: 26.95, 77.20; P <0.01), LOS (WMD=0.51; 95% CI: 0.00, 1.01; P <0.05), more EBL (WMD=92.99; 95% CI: 27.70, 158.28; P <0.01) and higher rates of hypertension (OR=6.03; 95% CI: 1.95, 18.61; P <0.01). CONCLUSIONS LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.
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Affiliation(s)
- Lijian Gan
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu Province, China
| | - Chunyang Meng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Lei Zheng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Zhiqiang Zeng
- Department of Urology, Affiliated Hospital of Southwest Medical University
- Department of Urology, Nanchong Central Hospital, Nanchong, Sichuan Province
| | - Si Ge
- Department of Urology, Affiliated Hospital of Southwest Medical University
- Department of Urology, Nanchong Central Hospital, Nanchong, Sichuan Province
| | - Zuoping Wang
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Kangsen Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Yunxiang Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
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Mazeh H, Weiss D, Peter M, Grozinsky-Glasberg S, Oleinikov K, Szalat A, Ronen A, Koganov E. Deliberate Compensated Vasoplegia-A Novel Pharmaceutical Approach for Controlling Blood Pressure During Surgery for Pheochromocytoma. World J Surg 2023; 47:985-994. [PMID: 36688933 DOI: 10.1007/s00268-023-06894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The most dreaded adverse event of pheochromocytoma surgery is operative severe blood pressure fluctuations. Preoperative protocols with alpha-blockade have achieved controversial results. No study to date evaluated the use of operative protocols in pheochromocytoma patients. Deliberated compensated vasoplegia (DCV) is a novel pharmaceutical regimen developed at our institution to decrease severe hypertensive events. The aim of this study is to compare outcomes of pheochromocytoma resection with and without DCV protocol. METHODS A retrospective analysis of all pheochromocytoma resections between the years 2012 and 2021 was performed. Resections performed with and without DCV protocol were compared. The primary outcome measured was the incidence of severe hypertension (MAP > 150 mmHg) during surgery. Secondary outcomes included other abnormal blood pressure measurements as well as perioperative data and complications. RESULTS A total of 41 resections were included, 21 performed under DCV protocol, and 20 without the protocol. Analysis demonstrated no significant difference in preoperative parameters including tumor size, catecholamine levels, and preoperative alpha-blockade protocol. The use of DCV protocol resulted in significant decrease in severe hypertension incidence from 1.95 ± 3.6 to 0.03 ± 0.13 events/h, p = 0.008. Application of the DCV protocol was not associated with any other adverse events. CONCLUSIONS This study suggests that DCV anesthesia protocol significantly decreases the incidence of severe hypertensive episodes during pheochromocytoma resection. This is the first study that describes a highly effective protocol for controlling hypertension in pheochromocytoma patients.
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Affiliation(s)
- Haggi Mazeh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Daniel Weiss
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Peter
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Department of Endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Neuroendocrine Tumor Unit, ENETS Center of Excellence, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kira Oleinikov
- Department of Endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Neuroendocrine Tumor Unit, ENETS Center of Excellence, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Auryan Szalat
- Department of Endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariel Ronen
- Department of Anesthesiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Evgeny Koganov
- Department of Anesthesiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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3
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Baio R, Pagano T, Molisso G, Di Mauro U, Intilla O, Albano F, Scarpato F, Giacometti S, Sanseverino R. When a Multidisciplinary Approach Is Life-Saving: A Case Report of Cardiogenic Shock Induced by a Large Pheochromocytoma. Diseases 2022; 10:29. [PMID: 35645250 PMCID: PMC9149903 DOI: 10.3390/diseases10020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pheochromocytoma is known for its instantaneous presentation, especially in the younger population. Hemodynamic instability may be the cause of severe complications and impede patients' ability to undergo surgical treatment. These tumours are surgically difficult to treat due to the risk of catecholamine release during their manipulations, and when they are large, the tumour size represents an additional challenge. In our report, cardiogenic shock developed due to increases in systemic vascular resistance, and the lesion's size induced surgeons to perform open surgery. CASE PRESENTATION A 46-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Systolic dysfunction was noted, along with severely increased systemic vascular resistance. A CT scan showed a left-sided 8.5 cm adrenal mass, which was confirmed as pheochromocytoma using meta-iodobenzylguanidine scintigraphy. Anaesthesiologists and the surgical team planned an effective strategy of treatment. Given the lesion's size and its apparent invasion of the neighbouring organs, open adrenalectomy (after prolonged hemodynamic stabilisation) was considered safer. The surgery was successful, and the patient remains free from disease two years after the initial event. CONCLUSIONS Large pheochromocytoma can be safely and effectively treated with open surgery by experienced hands but only by seeking to reach hemodynamic stabilisation and minimising the release of catecholamine before and during surgery.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, I-84081 Salerno, Italy
| | - Tommaso Pagano
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Giovanni Molisso
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Umberto Di Mauro
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Olivier Intilla
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Francesco Albano
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Fulvio Scarpato
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Stefania Giacometti
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
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Guo Y, Li H, Xie D, You L, Yan L, Li Y, Zhang S. Hemorrhage in pheochromocytoma surgery: evaluation of preoperative risk factors. Endocrine 2022; 76:426-433. [PMID: 35426588 PMCID: PMC9068676 DOI: 10.1007/s12020-021-02964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pheochromocytoma surgery carries a higher risk of hemorrhage. Our objective was to identify preoperative risk factors for hemorrhage during pheochromocytoma surgery. METHODS Patients who underwent surgery and with postoperative pathological confirmation were enrolled. A total of 251 patients from our center were included in the investigation, and 120 patients from the First Affiliated Hospital, Sun Yat-sen University were included as an external validation dataset. Family and medical history, demographics, hemodynamics, biochemical parameters, image data, anesthesia and operation records, postoperative outcomes were collected. Postoperative complications were graded by the Clavien-Dindo classification. Correlation between intraoperative hemorrhage volume and postoperative outcomes was assessed. The features associated with intraoperative hemorrhage were identified by linear regression. All features that were statistically significant in the multiple linear regression were then used to construct models and nomograms for predicting intraoperative hemorrhage. The constructed models were evaluated by Akaike Information Criterion. Finally, internal and external validations were carried out by tenfold cross-validation. RESULTS Intraoperative hemorrhage volume was positively correlated with the postoperative hospitalization time (R = 0.454, P < 0.001) and the Clavien-Dindo grades (R = 0.664, P < 0.001). Features associated with intraoperative hemorrhage were male gender (β = 0.533, OR = 1.722, P = 0.002), tumor diameter (β = 0.027, OR = 1.027, P < 0.001), preoperative CCB use (β = 0.318, OR = 1.308, P = 0.123) and open surgery (β = 1.175, OR = 3.234, P < 0.001). Validations showed reliable results (internal (R = 0.612, RMSE = 1.355, MAE = 1.111); external (R = 0.585, RMSE = 1.398, MAE = 0.964)). CONCLUSION More intraoperative hemorrhage is correlated with longer postoperative hospitalization time and more severe postoperative complications. Male gender, larger tumor, preoperative CCB use and open surgery are preoperative risk factors for hemorrhage in PCC surgery.
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Affiliation(s)
- Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dingxiang Xie
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Zavaruev AV, Mazurenko AA, Komarov RN, Anikin SV. [Surgical treatment of recurrent locally advanced pheochromocytoma]. Khirurgiia (Mosk) 2022:124-126. [PMID: 36469479 DOI: 10.17116/hirurgia2022121124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors present a patient with locally advanced recurrent pheochromocytoma of the left adrenal gland three years after open adrenalectomy. The patient underwent resection of recurrent tumor of the left adrenal gland, left-sided nephrectomy, splenectomy, resection of pancreatic tail, left dome of the diaphragm and descending colon. Postoperative period was uneventful. The patient was discharged in 12 days after surgery.
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Affiliation(s)
- A V Zavaruev
- Amur State Medical Academy, Blagoveshchensk, Russia
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - A A Mazurenko
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - R N Komarov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - S V Anikin
- Amur State Medical Academy, Blagoveshchensk, Russia
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Hue JJ, Alvarado C, Bachman K, Wilhelm SM, Ammori JB, Towe CW, Rothermel LD. Outcomes of malignant pheochromocytoma based on operative approach: A National Cancer Database analysis. Surgery 2021; 170:1093-1098. [PMID: 33958205 DOI: 10.1016/j.surg.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pheochromocytoma is often managed with adrenalectomy. Most literature focusing on postoperative outcomes are from single institutions. This study aimed to describe outcomes of adrenalectomy for malignant pheochromocytoma using a national database. We hypothesized that minimally invasive approaches might be associated with improved short-term outcomes but potentially inferior oncologic efficacy. METHODS Patients who underwent adrenalectomy for malignant pheochromocytoma were identified in the National Cancer Database (2010-2016). Patients were categorized as minimally invasive adrenalectomy or open adrenalectomy. Short- and long-term outcomes were compared. RESULTS A total of 276 patients underwent adrenalectomy for malignant pheochromocytoma: 50.7% open adrenalectomy and 49.3% minimally invasive adrenalectomy. Demographics were similar, except those who underwent open adrenalectomy had larger tumors compared to minimally invasive adrenalectomy (8.2 cm vs 4.7 cm; P < .001). Tumor size ≥6 cm was associated with a reduced likelihood of minimally invasive adrenalectomy (relative to open adrenalectomy) on multivariable regression (odds ratio = 0.23; P < .001). Open adrenalectomy was associated with longer duration of stay relative to minimally invasive adrenalectomy (6 vs 3 days; P < .001). Rates of positive margins, unplanned readmissions, or 30-/90-day mortalities were similar based on operative approach. Five-year survival rates were similar (open adrenalectomy 74.3%, minimally invasive adrenalectomy 79.1%). There was no association between overall survival and operative approach on multivariable Cox analysis when controlling for tumor size, laterality, and clinicodemographic variables. CONCLUSION Patients with larger malignant pheochromocytomas were more likely to undergo an open adrenalectomy. With the exception of an increased duration of stay, there was no difference in short- or long-term postoperative outcomes. These data suggest that minimally invasive adrenalectomy appears safe among tumors <6 cm.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, OH. https://twitter.com/jj_hue
| | - Christine Alvarado
- Department of Surgery, University Hospitals Cleveland Medical Center, OH. https://twitter.com/calvaradomd
| | - Katelynn Bachman
- Department of Surgery, University Hospitals Cleveland Medical Center, OH
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, OH
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, OH. https://twitter.com/ammorijohn
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, OH
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, OH.
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7
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Guo Y, You L, Hu H, Tong A, Zhang X, Yan L, Zhang S. A Predictive Nomogram for Red Blood Cell Transfusion in Pheochromocytoma Surgery: A Study on Improving the Preoperative Management of Pheochromocytoma. Front Endocrinol (Lausanne) 2021; 12:647610. [PMID: 33790869 PMCID: PMC8006300 DOI: 10.3389/fendo.2021.647610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Surgery is the major treatment option for pheochromocytoma but carries potential risks, including hemorrhage and hemodynamic instability. Even with laparoscopic adrenalectomy, intraoperative blood transfusion happens from time to time, but few studies have investigated risk factors. For the first time we develop and validate a nomogram for prediction of red blood cell transfusion in pheochromocytoma surgery. Methods There were 246 patients in our center and 56 patients in Peking Union Medical College Hospital, who underwent pheochromocytoma surgery, enrolled in the study. We incorporated clinical and radiological risk factors, and presented this with a nomogram. Lasso regression model was used for feature selection. Logistic regression analysis was performed to identify the odd ratios. The performance of the nomogram was assessed with respect to its discrimination, calibration and clinical usefulness. Results Thirty-two features were reduced to five, which were phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction heart rate, tumor diameter and surgical procedure. The model showed good discrimination (C-index, 0.857; 95% CI, 0.781-0.836) and application in the validation sets also gave good discrimination (internal validation: C-index, 0.831; 95% CI, 0.750-0.822; external validation: C-index, 0.924; 95% CI, 0.766-1.000). Calibration tested with the Hosmer-Lemeshow test yielded a good agreement between prediction and observation (training P=0.358; internal validation P=0.205; external validation P=0.395). Odd ratios of phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction HR, tumor diameter and open surgery were 13.32 (95% CI, 1.48-197.38; P = 0.034), 1.04 (95% CI, 0.99-1.08; P = 0.092), 1.04 (95% CI, 1.01-1.08; P=0.006), 1.03 (95% CI, 1.02-1.06; P<0.001), 17.13 (95% CI, 5.18-78.79; P<0.001), respectively. Decision curve analysis demonstrated the clinical usefulness of the nomogram. Conclusions This study presents a nomogram that may be used to facilitate the prediction of red blood cell transfusion in pheochromocytoma surgery and help to do the preoperative management more efficiently.
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Affiliation(s)
- Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anli Tong
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaoyun Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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8
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Holscher I, van den Berg TJ, Dreijerink KMA, Engelsman AF, Nieveen van Dijkum EJM. Recurrence Rate of Sporadic Pheochromocytomas After Curative Adrenalectomy: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2021; 106:588-597. [PMID: 33125073 DOI: 10.1210/clinem/dgaa794] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence on follow-up duration for patients with sporadic pheochromocytomas is absent, and current guidelines of the European Society of Endocrinology, American Association of Clinical Endocrinologists and Endocrine Surgeons, and the Endocrine Society are ambiguous about the appropriate duration of follow-up. The aim of this systematic review and meta-analysis is to evaluate the recurrence rate of sporadic pheochromocytomas after curative adrenalectomy. MATERIALS AND METHODS A literature search in PubMed, Embase, and the Cochrane Library was performed. A study was eligible if it included a clear report on the number of sporadic patients, recurrence rate, and follow-up duration. Studies with an inclusion period before 1990, <2 years of follow-up, <10 patients, and unclear data on the sporadic nature of pheochromocytomas were excluded. A meta-analysis on recurrence was performed provided that the heterogeneity was low (I2 < 25%) or intermediate (I2 26-75%). Hozo's method was used to calculate weighted mean follow-up duration and weighted time to recurrence with combined standard deviations (SDs). RESULTS A total of 13 studies, including 430 patients, were included in the synthesis. The meta-analysis results describe a pooled recurrence rate after curative surgery of 3% (95% confidence interval: 2-6%, I2 = 0%), with a weighted mean time to recurrence of 49.4 months (SD = 30.7) and a weighted mean follow-up period of 77.3 months (SD = 32.2). CONCLUSIONS This meta-analysis shows a very low recurrence rate of 3%. Prospective studies, including economical and health effects of limited follow-up strategies for patients with truly sporadic pheochromocytomas should be considered.
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Affiliation(s)
- Isabelle Holscher
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, AZ, The Netherlands
| | - Tijs J van den Berg
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Amsterdam, AZ, The Netherlands
| | - Koen M A Dreijerink
- Amsterdam UMC, VU University Medical Center, Department of Endocrinology, Amsterdam, HV, The Netherlands
| | - Anton F Engelsman
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, HV, The Netherlands
| | - Els J M Nieveen van Dijkum
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, AZ, The Netherlands
- ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ, The Netherlands
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Cicek MC, Gunseren KO, Senol K, Vuruskan H, Yavascaoglu I. Is 6 cm Diameter an Upper Limit for Adrenal Tumors to Perform Laparoscopic Adrenalectomy? J Laparoendosc Adv Surg Tech A 2020; 31:301-305. [PMID: 32716248 DOI: 10.1089/lap.2020.0505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: We aimed to compare the results of patients who underwent laparoscopic adrenalectomy (LA) for masses ≥6 cm versus <6 cm in diameter in our tertiary referral university hospital. Materials and Methods: Three hundred thirty consecutive patients were divided into two groups according to tumor size (≥6 and <6 cm in diameter). Demographic variables, body mass index (BMI), lesion localization (right/left), tumor diameter, pathological diagnosis and surgical outcomes, including operation time, estimated blood loss (EBL), conversion to open surgery, complications, and length of hospital stay were compared between groups. Results: Between February 2008 and March 2020, 53 patients (29 male-24 female) with ≥6 cm (L group) adrenal tumor and 277 patients (105 male-172 female) with <6 cm tumor (S group) underwent transperitoneal LA. One hundred sixty-eight (50.9%) tumors localized on the left side. In L group mean tumor size in female and male patients was 87.5 ± 40.8 mm (range 50-225 mm) and 67.3 ± 18.4 mm (range 10-100 mm), respectively (P < .05). Age, American Society of Anesthesiology scores, BMI, and mean operation time were similar between groups (P > .05). Postoperative complications were more often in L group (P = .005). EBL in group L and group S was 86 ± 70.4 mL (range 10-500 mL) and 55 ± 44.2 mL (range 10-300 mL), respectively (P = .003). Length of hospital stay in group L and group S was 3.7 ± 3.5 days (range 1-26) and 3 ± 1.6 days (range 1-9), respectively (P = .086). Significant variables in multivariate analysis, including gender (male), EBL, and postoperative complication rate, were entered into multivariate regression analysis, which presented that EBL and postoperative complication rates were independent significants for the L group. Conclusion: Six centimeters should not be considered as an upper limit of transperitoneal lateral LA and may be safely performed in centers with experience. Further studies are needed to confirm our data.
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Affiliation(s)
| | - Kadir Omur Gunseren
- Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Kazım Senol
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ismet Yavascaoglu
- Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Mazzaglia PJ, Varghese J, Habra MA. Evaluation and management of adrenal neoplasms: endocrinologist and endocrine surgeon perspectives. Abdom Radiol (NY) 2020; 45:1001-1010. [PMID: 32189021 DOI: 10.1007/s00261-020-02464-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The evaluation and management of adrenal disease is a complex endeavor that relies on an expert knowledge of human physiology and anatomy. Careful and proper patient assessment mandates a balanced approach which marries the disciplines of endocrinology, surgery, and radiology. Any of these three specialties may be on the front line in performing the initial workup when an adrenal neoplasm is discovered. With an ever-increasing volume of cross-sectional imaging, be it CT, MRI, or PET, large numbers of adrenal incidentalomas are being discovered. A close collaboration amongst specialties should strive to streamline the initial evaluation and minimize unnecessary testing and treatment.
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11
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Wang H, Wu B, Yao Z, Zhu X, Jiang Y, Bai S. Nomogram for predicting severe morbidity after pheochromocytoma surgery. Endocr Connect 2020; 9:309-317. [PMID: 32182582 PMCID: PMC7159264 DOI: 10.1530/ec-20-0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Although resection is the primary treatment strategy for pheochromocytoma, surgery is associated with a high risk of morbidity. At present, there is no nomogram for prediction of severe morbidity after pheochromocytoma surgery, thus the aim of the present study was to develop and validate a nomogram for prediction of severe morbidity after pheochromocytoma surgery. METHODS The development cohort consisted of 262 patients who underwent unilateral laparoscopic or open pheochromocytoma surgery at our center between 1 January 2007 and 31 December 2016. The patients' clinicopathological characters were recorded. The least absolute shrinkage and selection operator (LASSO) binary logistic regression model was used for data dimension reduction and feature selection, then multivariable logistic regression analysis was used to develop the predictive model. An independent validation cohort consisted of 128 consecutive patients from 1 January 2017 and 31 December 2018. The performance of the predictive model was assessed in regards to discrimination, calibration, and clinical usefulness. RESULTS Predictors of this model included sex, BMI, coronary heart disease, arrhythmia, tumor size, intraoperative hemodynamic instability, and surgical duration. For the validation cohort, the model showed good discrimination with an AUROC of 0.818 (95% CI, 0.745, 0.891) and good calibration (Unreliability test, P = 0.440). Decision curve analysis demonstrated that the model was also clinically useful. CONCLUSIONS A nomogram was developed to facilitate the individualized prediction of severe morbidity after pheochromocytoma surgery and may help to improve the perioperative strategy and treatment outcome.
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Affiliation(s)
- Hongyan Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunzhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence should be addressed to S Bai:
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Prakash P, Ramachandran R, Tandon N, Kumar R. Open surgery for pheochromocytoma: Current indications and outcomes from a retrospective cohort. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2020; 36:21-25. [PMID: 31983822 PMCID: PMC6961438 DOI: 10.4103/iju.iju_186_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: Minimally invasive approaches are the current standard of care for pheochromocytoma/paraganglioma (PC/PG) surgery. However, a number of patients still undergo open surgery for these tumors. We evaluated the current indications and outcomes of open surgery for PC/PG to define the role of this approach. Methods: Data of patients undergoing PC/PG surgery between July 2008 and July 2017 were retrieved from our prospectively maintained electronic database and hospital records. Tumor characteristics, operative and recovery parameters, and complications were evaluated for indications of open procedure and outcomes. Results: During the study period, 106 patients underwent 124 procedures for PC/PG, including 18 simultaneous bilateral procedures. Surgeries included 102 adrenalectomies, 18 PG excisions, one partial adrenalectomy, and three partial cystectomies. Twenty-five (23.6%) patients (mean age 38.2 ± 16.1 years) underwent an open procedure, including four bilateral procedures. This included 16 adrenalectomies and 9 PG excisions. The indications for open surgery were unilateral large tumours (5; size 8–16, mean 11 cm), bilateral large tumours (2; size 6–10, mean 8.2 cm), retrocaval tumour extension (4), inter aortocaval PGs (8), Retro-mesenteric PG (1), concomitant procedures (3), and conversion from laparoscopy (2). Mean operative time was 217 ± 63.8 min, blood loss was 868 ± 734.2 ml, 11 patients required blood transfusion, and hospital stay was 6.44 ± 2.4 days. All these parameters were higher than for minimally invasive surgery (MIS) in this cohort. Three patients (12%) suffered a postoperative complication, and the rate of complications was not higher than MIS cohort (16%). Conclusions: Open surgery was most often indicated for large tumors or those located in the inter-aortocaval region. Most such procedures require large incisions and possible hepatic mobilization on the right side. The procedures can be safely completed with few complications.
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Affiliation(s)
- Pradeep Prakash
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Dalcı K, Topal U, Ünal AG, Eray İC, Yalav O, Sakman G. Adrenal kitlelerde laparaskopik ve açık cerrahi tekniklerin sonuç açısından karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.570824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Maestroni U, Ziglioli F, Baciarello M, Bellini V, Dalla Valle R, Cataldo S, Maspero G, Bignami E. Multidisciplinary management of a large pheochromocytoma presenting with cardiogenic shock: a case report. BMC Urol 2019; 19:118. [PMID: 31747934 PMCID: PMC6868789 DOI: 10.1186/s12894-019-0554-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 11/08/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pheochromocytoma is well-known for sudden initial presentations, particularly in younger patients. Hemodynamic instability may cause serious complications and delay a patient's ability to undergo surgical resection. Larger tumors present a further challenge because of the risk of catecholamine release during manipulations. In the case we present, increases in systemic vascular resistance caused cardiogenic shock, and the size of the lesion prompted surgeons to veer off from their usual approach. CASE PRESENTATION A 38-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Profound systolic dysfunction (left ventricular ejection fraction of 0.12) was noted together with severely increased systemic vascular resistance, and gradually responded to vasodilator infusion. A left-sided 11-cm adrenal mass was found with computed tomography and confirmed a pheochromocytoma with a meta-iodo-benzyl-guanidine scintigraphy. Surgical treatment was carefully planned by the endocrinologist, anesthesiologist and surgeon, and was ultimately successful. After prolonged hemodynamic stabilization, open adrenalectomy and nephrectomy were deemed safer because of lesion size and the apparent invasion of the kidney. Surgery was successful and the patient was discharged home 5 days after surgery. She is free from disease at almost 2 years from the initial event. CONCLUSIONS Large, invasive pheochromocytoma can be safely and effectively managed with open resection in experienced hands, provided all efforts are made to achieve hemodynamic stabilization and to minimize. Catecholamine release before and during surgery.
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Affiliation(s)
- Umberto Maestroni
- Department. of General and Specialty Surgery, Urology Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Ziglioli
- Department. of General and Specialty Surgery, Urology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Baciarello
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy.
| | - Valentina Bellini
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
| | - Raffaele Dalla Valle
- Department of Medicine and Surgery, Hepatobiliary Surgery Unit, University of Parma, Parma, Italy
| | - Simona Cataldo
- Department of Medicine, Endocrinology and Metabolic Diseases Unit, University Hospital of Parma, Parma, Italy
| | - Giada Maspero
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
| | - Elena Bignami
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
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Balla A, Palmieri L, Meoli F, Corallino D, Ortenzi M, Ursi P, Guerrieri M, Quaresima S, Paganini AM. Are Adrenal Lesions of 6 cm or More in Diameter a Contraindication to Laparoscopic Adrenalectomy? A Case–Control Study. World J Surg 2019; 44:810-818. [DOI: 10.1007/s00268-019-05287-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Bai S, Wu B, Yao Z, Zhu X, Jiang Y, Bu R. Development and validation of a predictive model for predicting cardiovascular morbidity in patients after pheochromocytoma surgery. Clin Endocrinol (Oxf) 2019; 91:490-497. [PMID: 31278868 DOI: 10.1111/cen.14057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/30/2019] [Accepted: 07/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although surgical resection is the primary treatment method for pheochromocytoma, it carries a high risk of morbidity, especially cardiovascular-related morbidity. There are no models for predicting cardiovascular morbidity after pheochromocytoma surgery. Thus, we developed and validated a model for the preoperative prediction of cardiovascular morbidity after pheochromocytoma surgery. DESIGN The development cohort consisted of 262 patients who underwent unilateral laparoscopic or open pheochromocytoma surgery at our centre between 1 January 2007 and 31 December 2016. Patient's clinicopathologic data were recorded. The LASSO regression was used for data dimension reduction and feature selection; then, multivariable logistic regression analysis was used to develop the prediction model. An independent cohort consisting of 112 consecutive patients from 1 January 2017 and 31 December 2018 was used for validation. The performance of this prediction model was assessed with respect to discrimination, calibration and clinical usefulness. RESULTS The predictors in this prediction model included body mass index, history of coronary heart disease, tumour size, intraoperative hemodynamic instability and use of crystal/colloid fluids preoperatively. In the validation cohort, the model showed good discrimination with an AUROC of 0.869 (95% CI, 0.797, 0.940) and good calibration (unreliability test, P = .852). Decision curve analysis demonstrated that the model was also clinically useful. CONCLUSION This study presented a good nomogram that could facilitate the preoperative individualized prediction of cardiovascular morbidity after pheochromocytoma surgery, which may help improve perioperative strategy and good treatment outcomes.
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Affiliation(s)
- Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunzhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Renge Bu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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Bai S, Yao Z, Zhu X, Li Z, Jiang Y, Wang R, Wen N. Risk factors for postoperative cardiovascular morbidity after pheochromocytoma surgery: a large single center retrospective analysis. Endocr J 2019; 66:165-173. [PMID: 30518721 DOI: 10.1507/endocrj.ej18-0402] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Surgical resection is the primary treatment strategy for pheochromocytoma; however, it carries a high risk of morbidity and mortality, especially with respect to cardiovascular complications, which is the most common kinds of morbidity. The risk factors for morbidity remain unclear and require further exploration, moreover no studies focus on risk factors for cardiovascular morbidity. Herein we identified the risk factors for cardiovascular morbidity after pheochromocytoma surgery in Chinese patients. We retrospectively reviewed 262 patients who underwent unilateral surgical resection of pheochromocytoma at our center between 1 January 2007 and 31 December 2016. Patient demographics and extensive perioperative data were recorded and evaluated. Adjusted odds ratios and 95% confidence intervals were determined by multivariate logistic regression. Cut-off values and the area under the curve for continuous risk factors were calculated based on receiver operating characteristic curve analysis. A p-value <0.05 was considered statistically significant. Of the 262 patients, 63 (24.0%) had cardiovascular morbidity. The independent risk factors for cardiovascular morbidity were low body mass index, large radiographic tumor size, coronary heart disease, no preoperative crystal/colloid administration, and intraoperative hemodynamic instability; the corresponding odds ratio were 0.762 (p < 0.001), 1.208 (p = 0.010), 2.378 (p = 0.012), 2.720 (p = 0.011), and 4.764 (p = 0.001), respectively. The optimal cut-off values for body mass index and radiographic tumor size were 24.59 kg/m2 and 6.05 cm. We found that cardiovascular morbidity is common in patients after pheochromocytoma surgery. We identified five independent risk factors for cardiovascular morbidity. Identification of these risk factors may help to improve treatment strategies.
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Affiliation(s)
- Song Bai
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
| | - Zichuan Yao
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
| | - Xianqing Zhu
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
| | - Zidong Li
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
| | - Yunzhong Jiang
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
| | - Rongzhi Wang
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
| | - Ning Wen
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang 110004, China
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Mohammed A, Amine H, Atiq SE, Mohammed B, Ouadii M, Khalid M, Khalid AT, Abdelmalek O. Applicability and outcome of laparoscopic adrenalectomy for large tumours. Pan Afr Med J 2018; 31:23. [PMID: 30918550 PMCID: PMC6430842 DOI: 10.11604/pamj.2018.31.23.15153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/20/2018] [Indexed: 01/30/2023] Open
Abstract
Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: < 5 or ≥ 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75% , P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P < 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.
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Affiliation(s)
- Alila Mohammed
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco
| | - Hamdane Amine
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco
| | - Sara El Atiq
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco
| | | | - Mouaqit Ouadii
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Mazaz Khalid
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Ait Taleb Khalid
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Ousadden Abdelmalek
- Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Benabdellah University, Fez, Morocco
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Liu H, Li B, Yu X, Huang Y. Perioperative management during laparoscopic resection of large pheochromocytomas: A single-institution retrospective study. J Surg Oncol 2018; 118:709-715. [PMID: 30175399 DOI: 10.1002/jso.25205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/22/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The safety of laparoscopic resection of very large pheochromocytomas is unclear, and preoperative preparation may benefit from refinement. This retrospective study was designed to determine the correlation between tumor size and perioperative characteristics by evaluating data from patients who underwent laparoscopic resection of pheochromocytomas. METHODS A total of 253 patients were grouped according to their tumor diameter: diameter ≥8 cm, Glarge (Glg ) (n = 30); diameter 6 to 8 cm, Gmedium (Gmd ) (n = 57); and diameter <6 cm, Gsmall (Gsm ) (n = 166). The perioperative data were compared among the three groups using the analysis of variance test, Wilcoxon's rank-sum test, and the chi-square test. RESULTS Patients in the Glg and Gmd groups had a higher preoperative phenoxybenzamine daily dose and 24-hour urine levels of noradrenaline and adrenaline than those in the Gsm group, as they needed longer vasopressor support. Transfusion of allogeneic blood products was found to be increased in patients of the Glg group compared with the other two groups and their intensive care unit stays were longer. CONCLUSIONS Compared with small-sized pheochromocytomas, laparoscopic resection of medium-sized pheochromocytomas requires vigilant monitoring and resolution of hemodynamic fluctuations. Patients with very large pheochromocytomas are at greater risk of intraoperative bleeding and may benefit from the ensured availability of blood products and intensive postoperative monitoring.
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Affiliation(s)
- Hongju Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Bin Li
- Department of Anesthesiology, Jiujiang Maternal and Child Care Centres, Jiangxi, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
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20
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Chung HS, Kim MS, Yu HS, Hwang EC, Kim SO, Oh KJ, Jung SI, Kang TW, Park K, Kwon DD. Laparoscopic adrenalectomy using the lateral retroperitoneal approach: Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm? Int J Urol 2018; 25:414-419. [PMID: 29478297 DOI: 10.1111/iju.13524] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/07/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the surgical feasibility of laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of large pheochromocytomas, and to identify the preoperative risk factors for intraoperative hypertension. METHODS We retrospectively reviewed 51 patients who underwent laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of pheochromocytomas. Patient characteristics and perioperative outcomes were analyzed and compared between the two study groups based on tumor size: group A (n = 27, ≤6 cm) and group B (n = 24, ˃6 cm). RESULTS There was no significant difference in preoperative characteristics between the two groups except for tumor size (P = 0.001) and urinary metanephrine (P = 0.011). Group B patients required longer operating time (P = 0.008), had a greater estimated blood loss (P = 0.001) and hemoglobin change (P = 0.002). However, no significant differences were observed in perioperative complications and mortality. Multivariate analysis showed that symptomatic pheochromocytomas (P = 0.004) and tumor size (P = 0.007) were significant risk factors for intraoperative hypertension. CONCLUSIONS Laparoscopic adrenalectomy using the lateral retroperitoneal approach for pheochromocytomas can be regarded as a treatment option, even for tumors measuring >6 cm. Symptomatic pheochromocytomas and large tumor size seem to represent risk factors for intraoperative hypertension.
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Affiliation(s)
- Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Soo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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21
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Zhang B, Chen Z, Hu X, He Y, Li M, Liu P, Du Y, Liu Y, Chen X. Application of Three-Dimensional Visualization Technology in Laparoscopic Surgery for Pheochromocytoma/Paraganglioma: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2018; 28:997-1002. [PMID: 29406808 DOI: 10.1089/lap.2017.0704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the feasibility of three-dimensional visualization technology (3DVT) with that of routine computed tomography (CT) examination during planning of laparoscopic surgery for pheochromocytoma (PHEO) and paraganglioma (PGL) and the effects on operative and postoperative outcomes. PATIENTS AND METHODS The clinical data for 36 patients who underwent laparoscopic surgery for PHEO/PGL in our department from January 2016 to April 2017 were analyzed retrospectively. Fourteen patients underwent laparoscopic surgery for PHEO/PGL after preoperative 3DVT-based assessment and 22 after conventional CT examination. The demographic parameters, surgical procedures used, and perioperative outcomes were compared between the two groups. Data were entered into a Microsoft Excel worksheet and analyzed using SPSS version 24.0. RESULTS No significant differences were found between the groups with regard to age, gender, body mass index, tumor size, surgical approach, estimated blood loss, mean length of hospital stay, number of hypertensive and hypotensive episodes during surgery, peak blood pressure (BP) values during tumor handling, and minimum values after tumor excision. However, the operating time was significantly shorter and the fluctuations in BP were significantly lower in the 3DVT group. CONCLUSIONS 3DVT is a feasible and useful preoperative assessment method in patients undergoing laparoscopic surgery for PHEO/PGL. This imaging technique accurately shows the relationship between the tumor and peripheral structures and aids the surgeon's understanding of the anatomic structure in the operative area and in surgical planning.
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Affiliation(s)
- Bo Zhang
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Xiheng Hu
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Minghao Li
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Peihua Liu
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Yongchao Du
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Yuhang Liu
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
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Thomaschewski M, Neeff H, Keck T, Neumann HPH, Strate T, von Dobschuetz E. Is there any role for minimally invasive surgery in NET? Rev Endocr Metab Disord 2017; 18:443-457. [PMID: 29127554 DOI: 10.1007/s11154-017-9436-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroendocrine tumors (NET) represent the variability of almost benign lesions either secreting hormones occurring as a single lesion up to malignant lesions with metastatic potential. Treatment of NET is usually performed by surgical resection. Due to the rarity of NET, surgical treatment is mainly based on the experience and recommendations of experts and less on the basis of prospective randomized studies. In addition, the development and establishment of new surgical procedures is made more difficult by their rarity. The development of laparoscopic-assisted surgery has significantly improved the treatment of many diseases. Due to the well-known advantages of laparoscopic surgery, this method has also been increasingly used to treat NET. However, due to limited comparative data, the assumed superiority of laparoscopic surgery in the area NET remains often unclear or not yet proven. This review focuses on the present usage of laparoscopic techniques in the area of NET. Relating to the current literature, this review presents the evidence of various laparoscopic procedures for treatment of adrenal, pancreatic and intestine NET as well as extraadrenal pheochromocytoma and neuroendocrine liver metastases. Further, this review focuses on recent new developments of minimally invasive surgery in the area of NET. Here, robotic-assisted surgery and single-port surgery are promising approaches.
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Affiliation(s)
- M Thomaschewski
- Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - H Neeff
- Department of Visceral and General Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - T Keck
- Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - H P H Neumann
- Section for Preventive Medicine, Department of Nephrology and General Medicine, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
| | - T Strate
- Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital University of Hamburg, Reinbek, Germany
| | - E von Dobschuetz
- Section of Endocrine Surgery, Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital University of Hamburg, Reinbek, Germany.
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Martins D, Rodrigues D, Melo M, Carrilho F. Laparoscopic adrenalectomy as an effective approach to massive bilateral pheochromocytomas. BMJ Case Rep 2017; 2017:bcr-2017-221009. [PMID: 28883010 DOI: 10.1136/bcr-2017-221009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pheochromocytomas are catecholamine-secreting neoplasms, arising from adrenomedullary chromaffin cells. In type 2 multiple endocrine neoplasia (MEN2) syndrome, pheochromocytomas are usually benign but with predisposition to be bilateral (50%-80% of cases).The authors present the case of a young patient diagnosed with uncommonly large bilateral cystic pheochromocytomas and simultaneous detection of medullary thyroid carcinoma. Molecular testing confirmed germline RET codon C634 mutation, consistent with MEN2A syndrome. The patient underwent bilateral laparoscopic adrenalectomy plus total thyroidectomy with central lymph node dissection without associated complications. The histopathological study of the surgical specimens revealed bilateral benign pheochromocytomas (Ki67 of 2%) and a medullary carcinoma of the thyroid T1bN0M0; R0, respectively. One year after surgery, the patient was considered free of disease.This case demonstrates that bilateral laparoscopic adrenalectomy can be a safe and feasible approach for phechromocytomas in MEN2 syndrome, even in lesions with large diameter. However, due to elevated possibility of recurrence, patients should maintain lifelong follow-up.
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Affiliation(s)
- Diana Martins
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal
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Preoperative risk factors for massive blood loss in adrenalectomy for pheochromocytoma. Oncotarget 2017; 8:79964-79970. [PMID: 29108378 PMCID: PMC5668111 DOI: 10.18632/oncotarget.20396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022] Open
Abstract
Background This retrospective analysis of patients who underwent adrenalectomy for pheochromocytoma aimed to determine preoperative risk factors for intraoperative massive blood loss. Preoperative identification of patients at high-risk of massive blood loss may be helpful in anesthesia management and preoperative preparation. Materials and Methods The study involved data of 268 patients who had undergone pheochromocytoma surgery at the Peking Union Medical College Hospital between January 1, 2013 and October 31, 2016. For analysis, the patients were grouped according to intraoperative blood loss: ≥ 20% of estimated blood volume (group A, n = 38) and < 20% of estimated blood volume (group B, n = 230). Perioperative characteristics were compared between the two groups. Significant variables were selected for a forward stepwise binary logistic regression analysis to determine the independent risk factors for massive blood loss. Results The two groups showed significant differences in tumor location, tumor size, operative approach, preoperative 24-hour urine level of total noradrenaline, preoperative hemoglobin concentration, phenoxybenzamine maximum daily dose, preoperative preparation time, intraoperative urine volume, crystalloid and colloidal fluid volumes, allogeneic red blood cell transfusion, plasma and autologous blood transfusion volumes, incidence of prolonged hypotension, postoperative drainage volume, lowest and discharge hemoglobin concentrations, length of stay in intensive care unit and length of postoperative hospitalization. Binary logistic regression analysis indicated increased risk of intraoperative massive blood loss in subjects with tumors proximal to vessels or other organs (odds ratio (OR): 4.227), with tumors ≥ 5 cm (OR: 7.321), or with preoperative preparation time of ≤ 14 days (OR: 17.747). Conclusions Tumors proximal to vessels and other organs or with maximum diameter of ≥ 5 cm (as shown by preoperative radiographic evidence), and preoperative preparation time of ≤ 14 days were independent risk factors of intraoperative massive blood loss in patients treated with adrenalectomy for pheochromocytoma.
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Taffurelli G, Ricci C, Casadei R, Selva S, Minni F. Open adrenalectomy in the era of laparoscopic surgery: a review. Updates Surg 2017; 69:135-143. [DOI: 10.1007/s13304-017-0440-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/01/2017] [Indexed: 12/27/2022]
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Rao N, Ramachandran R, Tandon N, Singh P, Kumar R. Laparoscopic adrenalectomy for pheochromocytoma-does size matter? A single surgeon comparative study. Transl Androl Urol 2016; 5:780-783. [PMID: 27785436 PMCID: PMC5071191 DOI: 10.21037/tau.2016.08.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Surgical difficulty in laparoscopic adrenalectomy for pheochromocytoma increases with tumor size. We compared single surgeon outcomes of laparoscopic adrenalectomy for pheochromocytomas in patients with tumors smaller or greater than 4 cm to assess safety of the procedure. Methods A retrospective review was performed of laparoscopic adrenalectomies for pheochromocytoma by a single surgeon over a 3-year period. All patients underwent lateral transperitoneal surgery. Operative and outcome data was retrieved and compared for tumors >4 cm versus smaller tumors. Results We performed 28 laparoscopic adrenalectomies on 24 patients including four simultaneous bilateral surgeries. Fifteen tumors were greater than 4 cm in size (mean 6.3 cm) while 13 were smaller (mean 2.9 cm). Both groups had similar operating time (138 vs. 116 min; P=0.2) and blood loss (181 vs. 143 mL; P=0.41). The small tumor group had four Clavien-Dindo grade 1 and one grade 3a complication while the large tumor group had three grade 1 complications. There were no conversions to open surgery. Eighteen patients (75%) did not require any anti-hypertensive medications post-operatively. Conclusions Tumor size does not impact outcomes of laparoscopic adrenalectomy for pheochromocytomas. Larger tumors are associated with similar operative time, blood loss and complications as smaller ones.
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Affiliation(s)
- Niren Rao
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India; ; Department of Urology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Serji B, Souadka A, Benkabbou A, Hachim H, Jaiteh L, Mohsine R, Ifrine L, Belkouchi A, El Malki HO. Feasibility and safety of laparoscopic adrenalectomy for large tumours. Arab J Urol 2016; 14:143-6. [PMID: 27489741 PMCID: PMC4963158 DOI: 10.1016/j.aju.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/21/2016] [Accepted: 04/25/2016] [Indexed: 01/02/2023] Open
Abstract
Objective To verify the feasibility and safety of laparoscopic adrenalectomy for large tumours, as since it was described, the laparoscopic approach for adrenalectomy has become the ‘gold standard’ for small tumours and for large and non-malignant adrenal tumours many studies have reported acceptable results. Patients and methods This is a retrospective study from a general surgery department from January 2006 to December 2013 including 45 patients (56 laparoscopic adrenalectomies). We divided patients into two groups according to tumour size: <5 or ⩾5 cm, we compared demographic data and peri- and postoperative outcomes. Results There was no statistical difference between the two groups for conversion rate (3.7% vs 11.7% P = 0.32), postoperative complications (14% vs 12%, P = 0.4), postoperative length of hospital stay (5 vs 6 days P = 0.43) or mortality (3.5% vs 0% P = 0.99). The only statistical difference was the operating time, at a mean (SD) 155 (60) vs 247 (71) min (P < 0.001). Conclusion Laparoscopic adrenalectomy for large tumours needs more time but appears to be safe and feasible when performed by experienced surgeons.
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Affiliation(s)
- Badr Serji
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco; Medical School, Mohammed the First University, Oujda, Morocco
| | - Amine Souadka
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Amine Benkabbou
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Hajar Hachim
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Lamin Jaiteh
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Raouf Mohsine
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Lahcen Ifrine
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Abdelkader Belkouchi
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Hadj Omar El Malki
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco; Medical Centre of Clinical Trials and Epidemiological Study and Biostatistical, Clinical Research and Epidemiological Laboratory, Medical School, Mohammed V University in Rabat, Morocco; Abulcasis International University of Health Sciences, Abulcasis Medical School, Rabat, Morocco
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Johnston PC, Mullan KR, Atkinson AB, Eatock FC, Wallace H, Gray M, Hunter SJ. Recurrence of Phaeochromocytoma and Abdominal Paraganglioma After Initial Surgical Intervention. THE ULSTER MEDICAL JOURNAL 2015; 84:102-6. [PMID: 26170485 PMCID: PMC4488930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 12/05/2022]
Abstract
BACKGROUND Clinical and biochemical follow up after surgery for phaeochromocytoma is essential with long term studies demonstrating recurrence frequencies between 6% and 23%. AIM To examine the characteristics and frequency of tumour recurrence in a regional endocrine referral centre, in patients with surgical resection of phaeochromocytoma (P) and abdominal paraganglioma (AP). METHODS We identified a cohort of 52 consecutive patients who attended our Regional Endocrinology & Diabetes Centre and retrospectively reviewed their clinical, biochemical and radiological data (between 2002 and 2013). After confirmation of early post-operative remission by negative biochemical testing, tumour recurrence was defined by demonstration of catecholamine excess with confirmatory imaging. RESULTS Phaeochromocytoma was confirmed histologically in all cases (43:P, 9:AP, mean-age:53 years). Open adrenalectomy was performed in 20 cases and laparoscopically in 32. Hereditary phaeochromocytoma was confirmed by genetic analysis in 12 (23%) patients. Median follow up time from initial surgery was 47 months, (range: 12 - 296 months), 49 patients had no evidence of tumour recurrence at latest follow-up. Three patients (6%) demonstrated tumour development, one in a patient with VHL which occurred in a contralateral adrenal gland, one sporadic case had local recurrence, and an adrenal tumour occurred in a patient with a SDHB gene mutation who had a previous bladder tumour. After initial surgery, the tumours occurred at 8.6, 12.0 and 17.7 years respectively. CONCLUSION In this study tumour development occurred in 6% of patients. Although tumour rates were low, careful and sustained clinical and biochemical follow up is advocated, as new tumour development or recurrence may occur long after the initial surgery is performed.
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Affiliation(s)
| | | | | | | | | | - Moyra Gray
- Department of Pathology, Royal Victoria Hospital, Belfast, UK
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Wilson J, Brooke A, Dunn J, Goodman A, Hamilton-Wood C, Vaidya B. Recurrent phaeochromocytoma along the laparoscopic portal sites. Intern Med J 2015; 45:359-61. [PMID: 25735583 DOI: 10.1111/imj.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J Wilson
- Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK
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Riedinger CB, Tobert CM, Lane BR. Laparoendoscopic single site, laparoscopic or open surgery for adrenal tumors: Selecting the optimal approach. World J Clin Urol 2014; 3:54-65. [DOI: 10.5410/wjcu.v3.i2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/07/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy (OS-A), minimally-invasive adrenalectomy (MI-A), and laparoendoscopic single-site adrenalectomy (LESS-A) remain unclear. A comprehensive English-language literature review was performed using MEDLINE/PubMED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors (> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors (< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.
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Abstract
The surgical treatment of adrenal tumours has evolved over the past century, as has our understanding of which hormones are secreted by the adrenal glands and what these hormones do. This article reviews the preoperative evaluation of patients with adrenal tumours that could be benign or malignant, including metastases. The biochemical evaluation of excess levels of hormones is discussed, as are imaging characteristics that differentiate benign tumours from malignant tumours. The options for surgical management are outlined, including the advantages and disadvantages of various open and laparoscopic approaches. The surgical management of adrenocortical carcinoma is specifically reviewed, including controversies in operative approaches as well as surgical management of invasive or recurrent disease.
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Affiliation(s)
- Barbra S Miller
- University of Michigan Health System, 1500 East Medical Center Drive, 2920F Taubman Center, Ann Arbor, MI 48109-5331, USA
| | - Gerard M Doherty
- Department of Surgery, Boston University, 75 East Newton Street, Boston, MA 02118, USA
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Satendra M, de Jesus C, Bordalo e Sá AL, Rosário L, Rocha J, Bicha Castelo H, Correia MJ, Nunes Diogo A. Reversible catecholamine-induced cardiomyopathy due to pheochromocytoma: case report. Rev Port Cardiol 2014; 33:177.e1-6. [PMID: 24684896 DOI: 10.1016/j.repc.2013.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/27/2013] [Accepted: 09/13/2013] [Indexed: 11/26/2022] Open
Abstract
Pheochromocytoma is a tumor originating from chromaffin tissue. It commonly presents with symptoms and signs of catecholamine excess, such as hypertension, tachycardia, headache and sweating. Cardiovascular manifestations include catecholamine-induced cardiomyopathy, which may present as severe left ventricular dysfunction and congestive heart failure. We report a case of pheochromocytoma which was diagnosed following investigation of dilated cardiomyopathy. We highlight the dramatic symptomatic improvement and reversal of cardiomyopathy, with recovery of left ventricular function after treatment.
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Affiliation(s)
- Milan Satendra
- Serviço de Cardiologia, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
| | - Cláudia de Jesus
- Serviço de Medicina, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Armando L Bordalo e Sá
- Serviço de Cardiologia, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luís Rosário
- Serviço de Cardiologia, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - José Rocha
- Serviço de Cirurgia II, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Henrique Bicha Castelo
- Serviço de Cirurgia II, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Maria José Correia
- Serviço de Cardiologia, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - António Nunes Diogo
- Serviço de Cardiologia, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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Satendra M, de Jesus C, Bordalo e Sá AL, Rosário L, Rocha J, Bicha Castelo H, Correia MJ, Nunes Diogo A. Reversible catecholamine-induced cardiomyopathy due to pheochromocytoma: Case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A, Napolitano S, Milone M, Pasquali D, Sinisi AA, Colantuoni V, Santini L. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg 2012; 11:152-6. [PMID: 23267853 DOI: 10.1016/j.ijsu.2012.12.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/22/2022]
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. AIM 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.
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Affiliation(s)
- Giovanni Conzo
- Department of Anaesthesiology, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Gen. Giordano Orsini 42, 80132 Naples, Italy.
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