Pheochromocytoma surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
* | * Surgery is the mainstay of treatment for [[pheochromocytoma]]. | ||
=== '''Adrenalectomy:''' === | === '''Adrenalectomy:''' === | ||
*[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and [[retroperitoneal]] approaches have been used successfully for non-[[Metastasis|metastatic]] [[abdominal]] pheochromocytomas.<ref name="pmid21494137">{{cite journal| author=Nehs MA, Ruan DT| title=Minimally invasive adrenal surgery: an update. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2011 | volume= 18 | issue= 3 | pages= 193-7 | pmid=21494137 | doi=10.1097/MED.0b013e32834693bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494137 }}</ref> | *[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and [[retroperitoneal]] approaches have been used successfully for non-[[Metastasis|metastatic]] [[abdominal]] pheochromocytomas.<ref name="pmid21494137">{{cite journal| author=Nehs MA, Ruan DT| title=Minimally invasive adrenal surgery: an update. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2011 | volume= 18 | issue= 3 | pages= 193-7 | pmid=21494137 | doi=10.1097/MED.0b013e32834693bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494137 }}</ref> | ||
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**Larger [[tumor]] size | **Larger [[tumor]] size | ||
**[[Postural hypotension]] after [[Alpha blocker|α-blockade]], and a [[mean arterial pressure]] above 100 mm Hg. | **[[Postural hypotension]] after [[Alpha blocker|α-blockade]], and a [[mean arterial pressure]] above 100 mm Hg. | ||
*The patient should receive [[glucocorticoid]] stress coverage in bilateral [[adrenalectomy]]. | *The patient should receive [[glucocorticoid]] stress coverage in bilateral [[adrenalectomy]]. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 22:11, 28 July 2020
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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] Mohammed Abdelwahed M.D[3]
Overview
Surgery is the mainstay of treatment for pheochromocytoma. Adrenalectomy, laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytomas.
Indications
- The mainstay of treatment for pheochromocytoma is surgery. Surgical resection is usually done for patients with either:
- Benign localized tumor
- Unilateral pheochromocytoma- Unilateral adrenalectomy
- Bilateral pheochromocytomas- cortical-sparing adrenalectomy.[1]
Surgery
- Surgery is the mainstay of treatment for pheochromocytoma.
Adrenalectomy:
- Laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytomas.[2]
- There are less complications associated with laparoscopic surgery than with open surgery. Catecholamine secretion falls to a normal level within a week.
- Major intraoperative complications include intraoperative tumor capsule rupture, hypertensive crisis, myocardial infarctions, or cerebrovascular hemorrhages. Hemodynamic instability after tumor resection is possible. Hypoglycemia can occur after tumor resection due to unopposed insulin effect after declining of catecholamines levels.[3]
- Severe hypotension can occur after removal of the gland due to decreased catecholamines level in blood and down-regulation of adrenergic receptors. It can be controlled by vasopressors induction.[4]
- Risk factors for complications during surgery include:
- High plasma norepinephrine concentration
- Larger tumor size
- Postural hypotension after α-blockade, and a mean arterial pressure above 100 mm Hg.
- The patient should receive glucocorticoid stress coverage in bilateral adrenalectomy.
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.