Current management of pheochromocytoma: about 50 cases

Study aim. - The aim of this retrospective study was to assess our experience of the laparoscopic surgery of pheochromocytoma. We report indications and results of laparoscopic and open adrenalectomy for pheochromocytoma. Patients and methods. - Between january 1994 and may 2002, 50 patients underwent laparoscopic or open adrenalectomy for pheocromocytoma. The perioperative hemodynamic parameters were assessed for each patient. In each case, urinary metanephrine levels were measured at the second month postoperatively. The long term outcome was assessed in 44 patients. The mean follow-up was 39 months. Results. - Ten patients underwent open adrenalectomy: 8 patients for unilateral tumors (tumor size was > 8cm in 7 cases) and 2 patients for bilateral tumors (1 recurrence and 1 cystic polylobed tumor). Fourty patients underwent laparoscopic adrenalectomy: in 32 cases, including I patient with a bilateral tumor, no conversion was performed (tumor size was < 5cm in 29 cases). In 8 cases (20%), a conversion to an open operation was performed. The reasons to convert were bleeding and periadrenal fibrosis in 7 cases. In laparoscopic adrenalectomy group, hemodynamic troubles were not more frequent, the hospital stay was shorter and there was no recurrence. Conclusion. - Laparoscopic adrenalectomy is the Gold standard procedure for patients with pheochromocytoma. But open adrenalectomy is sometimes indicated: tumor size > 8cm, periadrenal fibrosis, and recurrence tumor. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.