Laparoscopic Resection of Retroperitoneal Paragangliomas: A Comparison with Conventional Open Surgical Procedures

Paraganglioma (PGL) is a rare type of tumor that arises from the extra-adrenal paraganglia. Laparoscopic adrenalectomy is well established for the treatment of adrenal pheochromocytomas, but laparoscopic resection of PGLs is controversial. In this study, we compared the clinical outcomes of laparoscopic and conventional open surgical procedures for PGLs. We also analyze the safety and feasibility of laparoscopic technique for renal hilar PGLs.

A retrospective review of all patients who underwent resection of retroperitoneal PGLs from 2002 to 2014 in our hospital was performed. Twelve patients underwent open procedures, and 15 underwent laparoscopic procedures. The preoperative, intraoperative, and postoperative data were collected and analyzed.

PGLs located at the renal hilum were predominantly both in the Lap group (n = 9) and open group (n = 7). Laparoscopic procedures in 14 of 15 patients were effectively completed without conversion to open surgery; one case with renal hilar tumor was converted to open surgery because of bleeding. The baseline characteristic of the patients in each group was well equivalent with respect to patient age, gender, body mass index, and tumor size. In the Lap group, the perioperative indexes were significantly different from those of the open group (each p < 0.05), including operative time (217.36 ± 51.90 vs 175.67 ± 36.79; p = 0.029), estimated blood loss (80.71 ± 83.52 vs 172.50 ± 160.86 mL; p = 0.047), and postoperative hospital stay (5.64 ± 1.95 vs 8.58 ± 1.97 days; p = 0.001). However, the intraoperative hemodynamic parameters and intensive care unit stay days were similar in both the groups. The perioperative data of the two procedures for renal hilar PGLs were compared. The Lap group showed estimated blood loss, and postoperative hospital stay outcomes were more favorable than the open group. Other data were similar in both the groups.

Laparoscopic procedure is safe and feasible in the treatment of patients with retroperitoneal PGLs. Laparoscopic resection of PGLs from the renal hilum is technically challenging. However, it is possible to safely undertake laparoscopic resection of these tumors by an experienced surgeon.