Laparoscopic Adrenalectomy for Pheocromocytoma in Children: Is It Safe?

Abstract

PURPOSE Laparoscopic adrenalectomy (LA) is a safe and effective procedure for removal of adrenal masses in adults, but few reports describe this technique in children. Reports of LA for treatment of pheochromocytoma in children are even rarer. We present our experience with LA in the treatment of pheochromocytoma in three pediatric patients. MATERIAL AND METHODS LA was performed in fifteen children between 2001 and 2006. In three cases, aged 8, 9 and 14 years, the clinical diagnosis was pheochromocytoma. Two patients were male (one with a family history) and one female, and all presented with unilateral tumors. All underwent clinical evaluation and preoperative adrenergic blockade. The transperitoneal laparoscopic approach, under general anesthesia and titrated nitroprusside administration, was employed in all cases. We analyse the operative and anesthetic data, pathology and postoperative outcome of these patients. RESULTS Operative times were 162, 120 and 130 minutes. The tumor was completely ressected in all cases, and there were no conversions or perioperative or anesthetic complications, except moderate hypertensive peaks that required a surgical pause and nitroprusside administration. No patient required a blood transfusion. The postoperative hospital stays were 7, 2 and 8 days, respectively. Resolution of clinical and biochemical parameters was accomplished in all patients. No patient had tumor with microscopic malignant features, and there was no recurrence nor metastatic spread with a follow-up of 24, 36 and 15 months. CONCLUSIONS This series suggests that LA in cases of pheocromocitoma in pediatric patients is feasible and safe.