Pheochromocytoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
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Overview
Surgery is the mainstay of treatment for pheochromocytoma.
Surgery
- Surgical resection of pheochromocytoma is the treatment of choice for benign localized tumor.
- Patients with unilateral pheochromocytoma should undergo unilateral adrenalectomy, patients with bilateral pheochromocytomas or who develop pheochromocytoma in their remaining adrenal gland should undergo cortical-sparing adrenalectomy.[1] It may also be nescessary to perform a complete surgical resection of the affected adrenal gland.
Adrenalictomy:
- Laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytmas.[2]
- Complications are less in laparoscopic than open surgery. Catecholamine secretion falls to normal level within a week.
- Major intraoperative complications include: intraoperative tumor capsule rupture, hypertensive crisis, myocardial infarctions, or cerebrovascular haemorrhages. Hyperdynamic instability after tumor resection is poosible. Hypoglycemia can occur after tumour resection due to unopposed insulin effect after decline of catecholamines levels.[3]
- Severe hypotension can occur after removal of the gland due to decreased catecholamines level in blood and downregulation of adrenergic receptors. It can be controlled by vasopressors induction.[4]
- Risk factors for complications during surgery: high plasma NE concentration, larger tumor size, postural hypotension after α-blockade, and a MAP above 100 mm Hg.
References
- ↑ Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC (1996). "Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma". Surgery. 120 (6): 1064–70, discussion 1070-1. PMID 8957496.
- ↑ Nehs MA, Ruan DT (2011). "Minimally invasive adrenal surgery: an update". Curr Opin Endocrinol Diabetes Obes. 18 (3): 193–7. doi:10.1097/MED.0b013e32834693bf. PMID 21494137.
- ↑ Rafat C, Zinzindohoue F, Hernigou A, Hignette C, Favier J, Tenenbaum F; et al. (2014). "Peritoneal implantation of pheochromocytoma following tumor capsule rupture during surgery". J Clin Endocrinol Metab. 99 (12): E2681–5. doi:10.1210/jc.2014-1975. PMID 25188716.
- ↑ Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P (2004). "Laparoscopic surgery for pheochromocytoma". Eur Urol. 45 (2): 226–32. PMID 14734011.