One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg
University of California-San Francisco/Mount Zion Medical Center, 1600 Divisadero Street, San Francisco, CA 94115, USA. Archives of surgery (Chicago, Ill.: 1960)
(Impact Factor: 4.93).
09/2010; 145(9):893-7. DOI: 10.1001/archsurg.2010.159
Pheochromocytoma can be safely treated laparoscopically; "subclinical" pheochromocytoma is increasingly common.
Patients undergoing adrenalectomy for pheochromocytoma at our institution in 1994 to 2009.
Laparoscopic, hand-assisted, and open adrenalectomy.
Preoperative and postoperative clinical and biochemical data.
One hundred two patients (52 women, 50 men) with pheochromocytoma underwent 108 operations. Ninety-seven operations were laparoscopic; 7, open; and 4, converted from laparoscopic to hand assisted or open. Six operations were bilateral; 3 were subtotal cortex-sparing resections. Thirty-four patients (33%) presented with adrenal incidentaloma and minimal symptoms, 28 within the past decade. Ten patients had paragangliomas, 7 of whom underwent laparoscopic resection. The mean (SD) tumor size was 5.3 (2.8) cm. Seven patients had recurrence requiring reoperation; the mean length of time between initial operation and recurrence was 6 years (range, 6 months to 17 years). There were no perioperative deaths.
Laparoscopic adrenalectomy can be safely performed for pheochromocytoma in more than 90% of cases. More than one-third of patients presented with subclinical pheochromocytoma. Patients should be followed up closely because recurrence may develop several years after adrenalectomy.
Available from: PubMed Central
- "Incidental discovery of PPGLs on imaging is becoming an increasingly important mode of their diagnosis; for instance, the proportion of PCs detected incidentally is now 25–30% of all cases (Mannelli et al. 1999, Amar et al. 2005, Kopetschke et al. 2009, Shen et al. 2010). Specific imaging findings are discussed in more detail below. "
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ABSTRACT: The paraganglioma (PGL) syndromes types 1-5 are autosomal dominant disorders characterized by familial predisposition to PGLs, phaeochromocytomas (PCs), renal cell cancers, gastrointestinal stromal tumours and, rarely, pituitary adenomas. Each syndrome is associated with mutation in a gene encoding a particular subunit (or assembly factor) of succinate dehydrogenase (SDHx). The clinical manifestations of these syndromes are protean: patients may present with features of catecholamine excess (including the classic triad of headache, sweating and palpitations), or with symptoms from local tumour mass, or increasingly as an incidental finding on imaging performed for some other purpose. As genetic testing for these syndromes becomes more widespread, presymptomatic diagnosis is also possible, although penetrance of disease in these syndromes is highly variable and tumour development does not clearly follow a predetermined pattern. PGL1 syndrome (SDHD) and PGL2 syndrome (SDHAF2) are notable for high frequency of multifocal tumour development and for parent-of-origin inheritance: disease is almost only ever manifest in subjects inheriting the defective allele from their father. PGL4 syndrome (SDHB) is notable for an increased risk of malignant PGL or PC. PGL3 syndrome (SDHC) and PGL5 syndrome (SDHA) are less common and appear to be associated with lower penetrance of tumour development. Although these syndromes are all associated with SDH deficiency, few genotype-phenotype relationships have yet been established, and indeed it is remarkable that such divergent phenotypes can arise from disruption of a common molecular pathway. This article reviews the clinical presentations of these syndromes, including their component tumours and underlying genetic basis.
© 2015 The authors.
Endocrine Related Cancer 08/2015; 22(4):T91-T103. DOI:10.1530/ERC-15-0268 · 4.81 Impact Factor
Available from: Salvatore Napolitano
- "Moreover, a higher risk of malignancy and of capsular disruption with seeding is advocated. Currently indication to LA for lesions > 6 cm is still a matter of debate and experienced endocrine surgeons are divided between supporters [3,5-7] and detractors [8,9]. Nevertheless it has been shown that MA, allowing earlier mobilization, is associated with lower rates of pulmonary infections, thromboembolic complications and mortality than traditional surgery . "
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Minimal invasive adrenalectomy has become the procedure of choice to treat adrenal tumors with a benign appearance, ≤ 6 cm in diameter and weighing < 100 g. Authors evaluated medium- and long-term outcomes of laparoscopic adrenalectomy (LA), performed for ten years in a single endocrine surgery unit.
We retrospectively reviewed 88 consecutive patients undergone LA for lesions of adrenal glands from 2003 to 2013. The first 30 operations were considered part of the learning curve. Doxazosin was preoperatively administered in case of pheochromocytoma (PCC), while spironolactone and potassium were employed to treat Conn's disease. Perioperative cardiovascular status modifications and surgical and medium- and long-term results were analyzed.
Forty nine (55.68%) functioning tumors, and one (1.13%) bilateral adrenal disease were identified. In 2 patients (2.27%) a supposed adrenal metastasis was postoperatively confirmed, while in no patients a diagnosis of incidental primitive malignancy was performed. There was no mortality or major post operative complication. The mean operative time was higher during the learning curve. Conversion and morbidity rates were respectively 1.13% and 5.7%. Intraoperative hypertensive crises (≥180/90 mmHg) were observed in 23.5% (4/17) of PCC patients and were treated pharmacologically with no aftermath. There was no influence of age, size and operative time on the occurrence of PCC intraoperative hypertensive episodes. Surgery determined a normalization of the endocrine profile. One single PCC persistence was observed, while in a Conn's patient, just undergone right LA, a left sparing adrenalectomy was performed for a contralateral metachronous aldosteronoma.
LA, a safe, effective and well tolerated procedure for the treatment of adrenal neoplasms ≤ 6 cm, is feasible for larger lesions, with a similar low morbidity rate. Operative time has improved along with the increase of the experience and of the technological development. Preoperative adrenergic blockade did not prevent PCC intraoperative hypertensive crises, but facilitated the control of the hemodynamic stability.
BMC Surgery 10/2013; 13(Suppl 2). DOI:10.1186/1471-2482-13-S2-S5 · 1.40 Impact Factor
Available from: banglajol.info
04/2011; 6(1). DOI:10.3329/fmcj.v6i1.7413
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