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Posterior retroperitoneoscopic versus laparoscopic adrenalectomy in sporadic and MENIIA pheochromocytomas

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Abstract

Introduction

Retroperitoneal adrenalectomy (PRA) comprises an alternative approach in the management of adrenal tumors that has been set as the treatment of choice in our Institution. We assess the impact of PRA the management of hereditary and sporadic pheochromocytomas comparing its outcomes to the laparoscopic technique, in a case–controlled setting.

Patients and methods

From May 2008 to January 2013, 17 patients [5 males and 12 females, mean age: 51 yrs (range 26–73)] with pheochromocytomas underwent PRA. Demographics, tumor characteristics, operative time, complications, hospital stay, and postoperative pain (based on VAS score at days 1 and 3) were compared to 17 selected laparoscopic patient controls [7 males and 10 females, mean age 49 yrs (range 25–64)].

Results

17 patients, 11 with the sporadic form and 6 with MENIIA associated pheochromocytomas, comprised the retroperitoneoscopic group. 19 pheochromocytomas with a mean size 3.7 cm (range 1.7–7.0) at a mean operative time: 105.6 min (range 60–180) were accordingly excised. In the laparoscopic group, 13 patients had sporadic pheochromocytomas, whereas 4 patients had MENIIA syndrome. Mean tumor size of the laparoscopic series was 5.1 cm (range 1.7–8.5) at a mean operative time of 137 min (range 75–195). No mortality or conversions were encountered in both groups. No blood transfusions were needed. Mean visual analog scale pain scores were significantly lower for the retroperitoneoscopic group both on days 1 and 3 [0.94 (0–3) vs 4.15 (3–6), p < 0.001 and 0.06 (0–1) vs 3.5 (2–6) p < 0.001] respectively. Mean hospital stay for the patients of the retroperitoneoscopic group was significantly better than the laparoscopic group [(2.1 ± 0.24 days vs 40 ± 0.70 days) p < 0.001].

Conclusions

Retroperitoneoscopic adrenalectomy is associated with excellent clinical results in the management of sporadic and hereditary pheochromocytomas. Moreover, it appears to be superior to the laparoscopic approach, because it is faster and affords the patient with less pain and shorter hospital stay.

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Disclosures

Drs Andreas Kiriakopoulos MD, Dimitrios Linos MD and Athanassios Petralias PhD have no conflicts of interest or financial ties to disclose

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Authors and Affiliations

  1. Department of Surgery, Hygeia Hospital, Er. Stavrou 9-Kifissias Av, Athens, Greece

    Andreas Kiriakopoulos & Dimitrios Linos

  2. Department of Statistics, Athens University of Economics and Business, Athens, Greece

    Athanassios Petralias

  3. University of Athens Medical School, Athens, Greece

    Dimitrios Linos

Authors
  1. Andreas Kiriakopoulos
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  2. Athanassios Petralias
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  3. Dimitrios Linos
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Correspondence to Andreas Kiriakopoulos.

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Kiriakopoulos, A., Petralias, A. & Linos, D. Posterior retroperitoneoscopic versus laparoscopic adrenalectomy in sporadic and MENIIA pheochromocytomas. Surg Endosc 29, 2164–2170 (2015). https://doi.org/10.1007/s00464-014-3912-0

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  • DOI: https://doi.org/10.1007/s00464-014-3912-0

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