Abdominal paragangliomas: a quantitative prognostic score as predictive factor of the feasibility of the laparoscopic approach

The gold standard treatment for abdominal paraganglioma is the complete surgical excision. The surgical approach may be either open or laparoscopic. The aim of this study is to identify clinical-pathological predictive factors for the failure of the laparoscopic approach in the treatment of abdominal paragangliomas, with the aim of reducing the rate of conversion to the open technique. A retrospective review was conducted on the medical records of patients who underwent laparoscopic surgery for suspected abdominal paraganglioma. To validate parameters which usually act as predictive factors for the laparoscopic outcome in many other interventions, we retrospectively designed a quantitative prognostic score at the beginning of our experience with paragangliomas. The score was based on the clinical and pathological aspects of the disease, as the localization of the tumor in the abdominal cavity, its size, the proximity to major vessels, and the grade of vascularization. At the time of each patient's discharge, we retrospectively verified the score values. A group of 15 patients underwent laparoscopic surgery for abdominal paraganglioma. In two patients, laparoscopic procedures were converted to laparotomic approaches. Patients reporting a score of <= 3 were all successfully operated laparoscopically, while patients with a score between 5 and 6 were laparotomically converted. There are very few studies assessing the effectiveness of the laparoscopic technique in paragangliomas. The conversion rate of our procedures was still low compared to the mean rate reported in the major studies in the literature. Our scoring system, herewith presented, seeks to avoid time-consuming surgery, which may imply a high risk of intra-operative haemodynamic instability in such patients. The choice of the right approach would minimize blood loss and the consequent surgical stress, improving post-operation outcome.