Surgical Management of Pheochromocytoma in a Contemporary Setting

Abstract

Background: Pheochromocytomas are rare, with a reported incidence of 2 - 8 cases per million persons, per year. The clinical presentation of pheochromocytomas is highly variable, making diagnosis challenging. Occasionally, the potent effects of the catecholamines can also cause pheochromocytoma crisis which can be fatal with around 800 deaths in the United States annually. The aim of this project is to study the clinical presentation, sensitivity of biochemical tests and imaging studies, preoperative work-up, pathological findings and surgical results of patients with pheochromocytoma.

Methods: A prospective adrenalectomy database was reviewed from 1995 to 2009. The sub-group of patients with pheochromocytomas was identified. Their clinical findings, serum and urinary biochemistry results, imaging results, pre-op medical treatments, surgical approach, histopathology, and complications were reviewed.

Results: A total of 88 patients with 85 having adrenalectomy were identified. Of these 24 had pheochromocytomas with a mean age of 50 (range: 19 - 75); 14 males and ten females. Elevated urinary catecholamines (> 2 /span> upper normal limit) were identified in 90% of cases whilst CT imaging accurately localized all lesions (22 adrenal, 2 extra-adrenal). Pre-op medication: 75% (n = 18) required only single alpha-blockade agent, 25% (n = 6) of them combined alpha and beta-blockade. Surgery: 18 of the 22 adrenalectomies were attempted laparoscopically with 15 (83%) completed laparoscopically and the remainder (three) converted to open surgery due to adhesions or large tumor size. Four adrenalectomies were performed as planned open cases (two bilateral; two with tumors > 7.5 cm). All patients had benign pheochromocytomas. One patient developed post-operative pneumonia and one patient had post-op hypotension needing inotropic support for two days. All patients are alive and well, with no evidence of recurrent disease (minimum two year follow-up).

Conclusions: The majority of adrenalectomies may be safely performed laparoscopically with minimal complications. A multi-disciplinary approach contributes to successful outcomes with involvement extending beyond preoperative consideration of the diagnosis into accurate localization of lesions, medical treatment when appropriate, specialized anaesthetic involvement and intensive care support.




doi: http://dx.doi.org/10.4021/jcs188w