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Laparoscopic adrenalectomy for pheochromocytoma-does size matter? A single surgeon comparative study
Niren Rao1, Rashmi Ramachandran2, Nikhil Tandon3
1Department of Urology, All India Institute of Medical Sciences, New Delhi, India; ; Department of Urology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India.
Background:
Surgical difficulty in laparoscopic adrenalectomy for pheochromocytoma increases with tumor size. We compared single surgeon outcomes of laparoscopic adrenalectomy for pheochromocytomas in patients with tumors smaller or greater than 4 cm to assess safety of the procedure.
Methods:
A retrospective review was performed of laparoscopic adrenalectomies for pheochromocytoma by a single surgeon over a 3-year period. All patients underwent lateral transperitoneal surgery. Operative and outcome data was retrieved and compared for tumors >4 cm versus smaller tumors.
Results:
We performed 28 laparoscopic adrenalectomies on 24 patients including four simultaneous bilateral surgeries. Fifteen tumors were greater than 4 cm in size (mean 6.3 cm) while 13 were smaller (mean 2.9 cm). Both groups had similar operating time (138 vs. 116 min; P=0.2) and blood loss (181 vs. 143 mL; P=0.41). The small tumor group had four Clavien-Dindo grade 1 and one grade 3a complication while the large tumor group had three grade 1 complications. There were no conversions to open surgery. Eighteen patients (75%) did not require any anti-hypertensive medications post-operatively.
Conclusions:
Tumor size does not impact outcomes of laparoscopic adrenalectomy for pheochromocytomas. Larger tumors are associated with similar operative time, blood loss and complications as smaller ones.
