[The surgical treatment of malignant adrenal chromaphinomas]

Pheochromoblastoma (PHB) is a tumor developing from adrenal medulla and characterized by severe course and high mortality level (15%). The severity of patients' state determined not only by presence of cancerous growth, but also due to catecholamine hyperproduction. The author has analyzed the results of surgical treatment of 60 patients with PHB, which were in surgical clinic during 1968-2002 y.y. The most effective method of the treatment is surgery. The method of choice is a lumbotomic extraperitoneal approach. The eradication of malignant growth requires not only complete tumor removal in single capsule with the adrenal gland but also thorough revision of paranephric, paracaval and paraaortal lymphnodes. 38 patients (63.3%) from 60 underwent radical surgery followed by long-term remission. The remission of the disease in 3 patients (5%) was achieved only after reoperations. The disease persists in two patients though it is better controlled after the operation than earlier with medicine. 8 (13.3%) patients were diagnosed to have widespred metastases and were referred to symptomatic treatment. The recurrence of the disease after the primary surgery is a bad forecasting factor. The majority of the patients (55.8%) with the recurrence were incurable. In the rest of the cases the operative treatment led to the longterm remission only in 71.9% of the patients.