29 PERIOPERATIVE, FUNCTIONAL AND ONCOLOGIC OUTCOMES OF PARTIAL ADRENALECTOMY FOR MULTIPLE IPSILATERAL PHEOCHROMOCYTOMA

Abstract

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201129 PERIOPERATIVE, FUNCTIONAL AND ONCOLOGIC OUTCOMES OF PARTIAL ADRENALECTOMY FOR MULTIPLE IPSILATERAL PHEOCHROMOCYTOMA Gopal Gupta, Kelly Lin, W. Marston Linehan, Peter Pinto, and Gennady Bratslavsky Gopal GuptaGopal Gupta Bethesda, MD More articles by this author , Kelly LinKelly Lin Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , Peter PintoPeter Pinto Bethesda, MD More articles by this author , and Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.091AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial adrenalectomy (PA) is gaining acceptance as a treatment option for patients with pheochromocytoma (pheo). As of today, there is no literature on PA performed for synchronous multiple ipsilateral pheos at a single setting. We report on the perioperative, functional, and oncologic outcomes of patients treated with PA for multiple adrenal pheos. METHODS We reviewed the records of all patients who underwent PA at the NCI from January of 1994 to November 2010. Demographic, perioperative, and pathologic data were collected. The functional outcomes were examined by resolution of symptoms, normalization of catecholamines, and the need for steroid replacement. Oncologic outcomes were assessed via review of the most recent imaging for the presence of persistent or recurrent disease. RESULTS Of 121 consecutive PA performed since 1994, we identified 10 procedures performed in 8 patients for multiple ipsilateral pheos. Six patients (75%) had known hereditary syndromes predisposing them to pheos. One patient underwent staged bilateral PA and a second patient underwent simultaneous bilateral PA. All cases for multiple adrenal pheos were performed using minimally-invasive approach (4 with conventional laparoscopy and 5 with robotic assistance). Average surgical time was 228 min (110–357) and EBL was 125 mL (50–300). There were no perioperative complications. An average of 2.6 (2–4) tumors was resected per gland with the average largest tumor size of 2.3 cm (0.8–5). Of the 26 tumors removed, 24 were pheochromocytoma and 2 were adrenal-cortical hyperplasia. At a median follow-up of 12 months (1.2–28) all patients had resolution of their symptoms and normalization of catecholamine levels. Among two patients treated with PA on a solitary adrenal gland, one required steroid replacement post-operatively after removal of 4 tumors. On postoperative imaging only one patient had evidence of an ipsilateral adrenal nodule consistent with incomplete resection 2 months post operatively. CONCLUSIONS PA for resection of multiple pheochromocytoma is safe, feasible, and provides patients with promising functional and oncologic outcomes at early follow up. The procedure can be performed utilizing a minimally invasive approach. Although local recurrence rates are low, longer follow up is needed to establish durable oncologic efficacy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e11 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gopal Gupta Bethesda, MD More articles by this author Kelly Lin Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...