PD31-09 PARTIAL ADRENALECTOMY VERSUS TOTAL ADRENALECTOMY IN THE TREATMENT OF PHEOCHROMOCYTOMA IN PATIENTS WITH VON HIPPEL LINDAU

Abstract

INTRODUCTION AND OBJECTIVE: Pheochromocytomas are functional tumors of the adrenal gland, that have an incidence rate of approximately 20% in patients with Von Hippel Lindau (VHL). Traditional management of these tumors has been total adrenalectomy. However, adrenal sparing surgical techniques have been recommended as a standard of care for these tumors. This study queried the National Inpatient Sample (NIS) database to examine the utilization of partial adrenalectomy in the treatment of pheochromocytomas in patients with VHL. METHODS: All patients admitted to the hospital between 2005 and 2014 with a diagnosis of pheochromocytoma were identified in the NIS database. VHL patients were selected and admissions involving total and partial adrenalectomies were identified. Demographic and hospital characteristics were extracted, and differences were compared using descriptive statistics. RESULTS: There were 33,535 admissions of patients with pheochromocytomas who underwent an adrenalectomy, with 0.7% of these patients also having VHL. Of the patients with VHL, 33% underwent a partial adrenalectomy and 67% underwent total adrenalectomy. The average age of patients who had a partial adrenalectomy was 20 years and 31 years for patients who underwent a total adrenalectomy. The mean length of stay of patients who had a partial adrenalectomy was 4 days compared to 8 days for total adrenalectomy, however no differences were observed in the type of hospital where the patients were treated. In regard to comorbidities of patients who received a partial vs total adrenalectomy, no differences in the rates of hypertension [29% vs. 47%, p=0.34], coronary artery disease [0% vs. 0.9%, p=0.45], or diabetes mellitus [0% vs. 14%, p=0.22] were observed. No differences in rates of transfusion or post-operative adrenal insufficiency were observed [p=0.21 and 0.76 respectively]. CONCLUSIONS: Partial adrenalectomy offers the benefit of sparing adrenal tissue, which can reduce the probability of adrenal insufficiency and steroid dependence in patients with VHL who are at risk for recurrent tumors as well as bilateral disease involvement. This analysis demonstrated that the majority of VHL patients with pheochromocytomas underwent total adrenalectomy. Patients who underwent partial adrenalectomies were on average younger and had shorter lengths of stay. Despite recommendations, partial adrenalectomy continues to be under-utilized as a surgical management strategy for VHL pheochromocytomas. Source of Funding: N/A