Pheochromocytoma surgery
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Pheochromocytoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pheochromocytoma surgery On the Web |
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American Roentgen Ray Society Images of Pheochromocytoma surgery |
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Risk calculators and risk factors for Pheochromocytoma surgery |
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 is the treatment of choice for benign localized tumor.
- Given the complexity of perioperative management, and the potential for catastrophic intra and postoperative complications, such surgery should be performed only at centers experienced in the area.
- It may also be nescessary to perform a complete surgical resection of the affected adrenal gland(s).
- Adrenalictomy: Laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytmas. Complicationa 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. Prognosis Good prognosis pateints include: small tumor size, short duration of surgery, systolic blood pressure less than 160 mmhg, and low levels of urinary catecholamines.Postoperative hypotension can be avoided by adequate fluid replacement. Recurrence is more in patients with familial pheochromocytoma and extraadrenal tumors. Familial pheochromocytoma have a high incidence of bilateral disease. partial adrenalectomy is recommended for these patients with bilateral pheochromocytomas to prevent permanent glucocorticoid deficiency. Complete bilateral adrenalectomy is recommended for MEN2 patients. There is highrt rate of reccurence than in sporadic cases. Follow up for long duration after surgery is needed. Most patients should have annual biochemical screening. neck paragangliomas may be in the carotid sheath or in the carotid body and thus require proximal and distal vascular control for resection. Preoperative embolization may simplify carotid body tumor resection and reduce blood loss [24]. Most chest paragangliomas require a median sternotomy and may involve the heart and great vessels with cardiac bypass, although videoscopic removal may be possible in some cases [25].