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Changing trends in the management of phaeochromocytoma
J G Geoghegan1, M Emberton, S R Bloom
1Department of Endocrine Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Background:
The recent experience of a specialist endocrine surgery unit in the management of phaeochromocytoma is reviewed.
Methods:
Over a 14-year period (June 1978 to June 1992) 43 patients (14 men, 29 women) with a mean age of 42 years were referred with phaeochromocytoma.
Results:
Biochemical confirmation was usually by measurement of 24-h urinary vallinylmandelic acid. From 1980 venous sampling was replaced by computed tomography as the primary localizing procedure. 131I-meta-iodobenzylguanidine scintigraphy was used in all patients between 1984 and 1987, but selectively after that. With regard to the operative approach used, between 1978 and 1983 midline or flank incisions were used, and from 1984 to 1992 subcostal or posterior approaches were used predominantly. There was one operative (30-day) death. One patient died 24 months after operation from recurrent malignant phaeochromocytoma, and three patient died during follow-up from unrelated causes. The remaining patients (mean follow-up 30 months) have no evidence of recurrent phaeochromocytoma, although four remain on antihypertensive medication.
Conclusion:
Improved imaging of phaeochromocytoma obviates the need for transperitoneal exploration, allowing selected phaeochromocytomas to be successfully managed using an extraperitoneal approach.