49 LONG TERM OUTCOMES OF SIMULTANEOUS BILATERAL PARTIAL ADRENALECTOMY FOR PHEOCHROMOCYTOMAS

Abstract

You have accessJournal of UrologyAdrenal: Surgery + Tumors/Benign and Malignant Disease (Physiology and Pharmacology)1 Apr 201249 LONG TERM OUTCOMES OF SIMULTANEOUS BILATERAL PARTIAL ADRENALECTOMY FOR PHEOCHROMOCYTOMAS Nitin Yerram, Dmitry Volkin, Faisal Ahmed, Jeffery Nix, An Hoang, Gopal Gupta, Armine Smith, W. Marston Linehan, Adam Metwalli, and Peter A. Pinto Nitin YerramNitin Yerram Bethesda, MD More articles by this author , Dmitry VolkinDmitry Volkin Bethesda, MD More articles by this author , Faisal AhmedFaisal Ahmed Bethesda, MD More articles by this author , Jeffery NixJeffery Nix Bethesda, MD More articles by this author , An HoangAn Hoang Bethesda, MD More articles by this author , Gopal GuptaGopal Gupta Bethesda, MD More articles by this author , Armine SmithArmine Smith Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , Adam MetwalliAdam Metwalli Bethesda, MD More articles by this author , and Peter A. PintoPeter A. Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.093AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The long term management of patients with VHL and MENII is challenging due to their predisposition to develop multiple and bilateral adrenal pheochromocytomas over time. In these patients, a dilemma exists in balancing functional outcomes with morbidity associated with multiple surgeries. We examine the feasibility of performing simultaneous bilateral partial adrenalectomy and report on peri/post-operative outcomes. METHODS We queried our IRB-approved, prospectively maintained database to identify patients who underwent simultaneous bilateral partial adrenalectomy at the National Cancer Institute since 1994. Various operative parameters and functional outcomes were analyzed among those who met the inclusion criteria. RESULTS Thirteen patients who underwent simultaneous bilateral partial adrenalectomy were identified. All patients had confirmed VHL or MEN II germline mutations. The mean age and BMI for this group were 46 years (29-69) and 30 (20.7-44.3), respectively. The majority of the patients (9/13) had pheo-like symptoms such as hypertension, palpitations, dizziness, headaches, and diaphoresis. All patients had either elevated plasma/urine catecholamines and/or positive preoperative MIBG. The mean operative time and EBL were 470 minutes (285-630) and 492 ml (100-1700), respectively. Eight surgeries were done via laparoscopic approach without need for open conversion and five were done via an open approach. Three patients underwent concomitant surgeries including partial pancreatectomy, RPLND, and para-aortic mass resection. No patients required peri-operative steroids or had intra-operative complications. One patient experienced post-operative intussusception which resolved spontaneously. Final pathology revealed pheochromocytoma in all patients. The mean number of tumors resected and size was 2.93 and 3cm, respectively. Mean follow up was 7.8 years (2.7-14.1). No patients required chronic medical adrenal replacement. Only two patients required subsequent adrenal surgery for familial pheochromocytoma. All patients were symptom-free with normalization of catecholamines at follow up. CONCLUSIONS In carefully selected patients, simultaneous bilateral partial adrenalectomy is a technically feasible approach with acceptable morbidities and durable results. For patients with a familial predisposition to form multiple bilateral pheochromocytomas, adrenocortical function can be preserved while sparing the morbidity associated with multiple surgeries. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e21 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nitin Yerram Bethesda, MD More articles by this author Dmitry Volkin Bethesda, MD More articles by this author Faisal Ahmed Bethesda, MD More articles by this author Jeffery Nix Bethesda, MD More articles by this author An Hoang Bethesda, MD More articles by this author Gopal Gupta Bethesda, MD More articles by this author Armine Smith Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Adam Metwalli Bethesda, MD More articles by this author Peter A. Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...