POSTERIOR RETROPERITONEOSCOPIC vs LAPAROSCOPIC ADRENALECTOMY IN SPORADIC AND MEN2A PHEOCHROMOCYTOMAS

Andreas Kiriakopoulos, MD, Dimitrios Linos, MD. Hygeia Hospital.

Introduction: Retroperitoneal adrenalectomy comprises an alternative approach in the management of adrenal tumors that has been set as the treatment of choice in our Institution. Since pheochromocytoma constitute the most challenging adrenal pathology, we assess the impact of retroperitoneal adrenalectomy in the management of hereditary and sporadic pheochromocytomas comparing its outcomes to the laparoscopic technique, in a case-controlled setting

Patients and Methods: From May 2008 to January 2013, 17 patients (6 males and 11 females {mean age: 50yrs (range: 26-73)} with pheochromocytomas underwent posterior retroperitoneoscopic adrenalectomy. Demographics, tumor characteristics, operative time, complications, hospital stay and postoperative pain (based on VAS score at days 1 and 3) were compared to 17 selected laparoscopic patient controls

Results: 17 patients, 11 with the sporadic form and 6 with MENIIA associated pheochromocytomas, comprised the retroperitoneoscopic group. 18 pheochromocytomas with a mean size: 5 cm (range:1.7-7.3) at a mean operative time: 92.5 min (range:60-180) were accordingly excised. Seventeen patients, 10 females and 7 males {mean age of 49.2yrs (range: 25-64)} comprised the laparoscopic group. Twelve patients had sporadic pheochromocytomas, whereas 4 patients had MEN2A syndrome. Mean tumor size of the laparoscopic series was 5.1 cm (range: 1.7-8.5) at a mean operative time of 125 min (range:75-195). No mortality or conversions were encountered in both groups. No blood transfusions were needed. Mean visual analogue scale pain scores were significantly lower for the retroperitoneoscopic group both on days 1 and 3 {0.7 (0-1) vs 3.8 (3-6), P<0.05 and 0.2 (0-1) vs 3.2 (2-6) P<0.05 respectively. Mean hospital stay for the patients of the retroperitoneoscopic group was significantly better than the laparoscopic group (2.1±0.35 days vs 3.2±0.22days) (p< 0.05).

Conclusions: Retroperitoneoscopic adrenalectomy is associated with excellent clinical results in the management of sporadic and hereditary pheochromocytomas. Moreover, it appears to be superior to the laparoscopic approach, because it is faster and affords the patient with less pain and shorter hospital stay.

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