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Published in:

01-06-2008

Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma

Authors: Guido A. M. Tiberio, Gian Luca Baiocchi, Luca Arru, Claudia Agabiti Rosei, Simona De Ponti, Albert Matheis, Damiano Rizzoni, Stefano M. Giulini

Published in: Surgical Endoscopy | Issue 6/2008

Abstract

Background

Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors.

Methods

A prospective randomized study was conducted (2000–2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring.

Results

Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 ± 94 cc versus 48 ± 36 cc, p < 0.05) and operative time (180 ± 40 versus 158 ± 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p < 0.05). Long-term follow-up was always normal.

Conclusions

Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.

Fernandez-Cruz L, Taura P, Saenz A et al (1996) Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion. World J Surg 20:762–768PubMedCrossRef

Fernandez-Cruz L, Saenz A, Taura P et al (1998) Helium and carbon dioxide pneumoperitoneum in patients with pheochromocytoma undergoing laparoscopic adrenalectomy. World J Surg 22:1250–1255PubMedCrossRef

Flavio Rocha M, Faramarzi-Roques R, Tauzin-Fin P et al (2004) Laparoscopic surgery for pheochromocytoma. Eur Urol 45:226–232PubMedCrossRef

Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. NEJM 327:1033PubMed

Gagner M (1996) Laparoscopic adrenalectomy. Surg Clin North Am 76:523–537PubMedCrossRef

Hazzan D, Shiloni E, Golijanin D, Jurim O, Gross D, Reissman P (2001) Laparoscopic adrenalectomy for benign adrenal neoplasm. A comparative study. Surg Endosc 15:1356–1358CrossRef

Inabnet WB, Pitre J, Bernard D et al (2000) Comparison of the hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma. World J Surg 24:574–578PubMedCrossRef

Kebebew E, Duh QJ (1998) Benign and malignant pheochromocytoma. Diagnosis, treatment and follow-up. Surg Oncol Clin North Am 7:765–789

Kercher KW, Park A, Matthews BD et al (2002) Laparoscopic adrenalectomy for pheochromocytoma. Surg Endosc 16:100–102PubMedCrossRef

10.

Kercher KW, Novitsky YW, Park A, Matthews BD, Litwin DE, Heniford BT (2005) Laparoscopic curative resection of pheochromocytomas. Ann Surg 241:919–926PubMedCrossRef

11.

Lezoche E, Guerrieri M, Crosta F, Paganini A, D’Ambrosio G, Lezoche G, Campagnacci R (2008) Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Surg Endosc 22:522–526PubMedCrossRef

12.

Marescaux J, Mutter D, Wheeler MH (1996) Laparoscopic right and left adrenalectomies: surgical procedures. Surg Endosc 10:912–915PubMedCrossRef

13.

Miccoli P, Bendinelli C, Materazzi G, Iacconi P, Buccianti P (1997) Traditional versus laparoscopic surgery in the treatment of pheochromocytoma: a preliminary study. J Laparoendosc Surg 3:167–171CrossRef

14.

Mobius E, Nies C, Rothmund M (1999) Surgical treatment of pheochromocytomas: laparoscopic or conventional? Surg Endosc 13:35–39PubMedCrossRef

15.

Prinz RA (1995) A comparison of laparoscopic and open adrenalectomies. Arch Surg 130:489–492PubMed

16.

Proye C, Thevenin D, Cecat P, Petillot P, Carnaille B, Wemeau JL, Huglo D, Ernst O, Proye CA (1989). Exclusive use of calcium channels blockers in preoperative and intra-operative control of pheochromocytomas: hemodynamics and free catecholamines assays in ten consecutive patients. Surgery 106:1149–1154PubMed

17.

Sprung J, O’Hara JF, Gill IS, Abdelmalak B, Sarnaik A, Bravo EL (2000) Anesthetic aspects of laparoscopic and open adrenalectomy for pheochromocytoma. Urology 55:339–343PubMedCrossRef

18.

Tiberio GA, Piardi T, Cerea K, Ronconi M, Bertoloni G, Frassi E, Portolani N, Giulini SM (2005) Laparoscopic adrenalectomy: an initial experience. Chir Ital 57:273–278PubMed

19.

Toniato A, Boschin I, Bernante P, Opocher G, Guolo AM, Pelizzo MR, Mantero F (2007) Laparoscopic adrenalectomy for pheochromocytoma: is it really more difficult? Surg Endosc 21:1323–1326PubMedCrossRef

Title: Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma
Authors: Guido A. M. Tiberio
Gian Luca Baiocchi
Luca Arru
Claudia Agabiti Rosei
Simona De Ponti
Albert Matheis
Damiano Rizzoni
Stefano M. Giulini
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 6/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-9904-1

At a glance: The STEP trials

Springer Medicine

Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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