Endocrine Abstracts

Introduction: Laparoscopic adrenalectomy is a promising alternative to open surgery although concerns exist in regard to laparoscopic treatment of pheocromocytoma. This report aims to describe the outcomes of laparoscopic resection for pheocromocytoma focusing particularly on intraoperative hemodynamic stability and postoperative outcomes.

Methods/design: Descriptive analysis including patients who underwent laparoscopic surgery for unilateral pheochromocytoma in our center. Patients who required emergency surgery were excluded from analysis, so every patient received previous alfa and beta blockade. Patients who didn’t meet Roizen’s criteria before surgery and patients with bilateral tumours or paraganglioma were also excluded. Intraoperative hemodynamic stability including need of vasoactive drugs was studied. Postoperative complications and length of stay from post-anesthesia or intensive care unit admission to discharge to conventional medical ward, were recorded. Quantitative variables are described as median (range) or number of cases in which some particular clinical conditions were observed.

Results: Ten patients were included (six women, five men; median age: 53 (27–80) years. Median size of tumour: 2.8 (1.5–10) cm. Type of tumour secretion: norepinephrine (4), norepinephrine and epinephrine (4), norepinephrine, epinephrine and dopamine (2). Preoperative systolic blood pressure: 130 (120–140) mm Hg, diastolic blood pressure 80 (71.2–87.5) mm Hg and heart rate: 71 (65–85) bpm. All tumours were successfully removed. One laparoscopic procedure were converted to open procedure due to large mass size (above 10 cm). Intraoperative results: median operative time was 150 (90–180) min, median blood pressure was 92.5 (85–100) mm Hg, hypertensive crisis requiring use of vasoactive drugs and hypotensive crisis requiring volumen expanders were documented in 4 and 3 cases, respectively. No arrythmias were documented. Postoperative results: treatment for transient hypertension was needed in 2 cases, 2 patients suffered from hypoventilation and hypotension was found in 2. Median time from post-anesthesia/intensive care unit to discharge to conventional hospital ward: 48 (24–96) hours. Laparoscopic adrenalectomy was effective in normalization of endocrine profile in all cases.

Conclusions: Laparoscopic resection of pheochromocytomas can be accomplished safely by experienced surgeons. A short operative and post-anesthesia care wards stay with minimal intra and postoperative hemodynamic inestability coupled with eradication of endocrinopathy support the minimally invasive approach for adrenalectomy in the setting of pheochromocytoma.