Safety analysis of laparoscopic adrenalectomy for adrenal pheochromocytoma of 5 to 10 cm

Abstract

To investigate the safety of laparoscopic adrenalectomy for adrenal pheochromocytoma with maximum diameter of 5 - 10 cm. Retrospective analysis was performed for 79 consecutive patients who underwent adrenalectomy for adrenal pheochromocytoma between January 2001 and June 2007. Forty-one patients among these cases had tumors of maximum diameter of 5 - 10 cm. Nine patients who underwent laparoscopic procedures (the additional 2 cases were converted to open surgery and were excluded) were compared with 30 patients who underwent open procedures using two-tailed unpaired t tests or Mann-Whitney U tests. There was no significant difference in age, maximum diameter of tumor, the highest preoperative systolic/diastolic pressure, the preoperative heart rate and the plasma catecholamines between the two groups (P > 0.05). All laparoscopic procedures were performed by retroperitoneal approach. For open surgeries, 11 were performed by transperitoneal approach and 19 by retroperitoneal approach. We found significant differences between laparoscopic and open groups in the operative time, the blood loss, and postoperative hospital stay. Blood-transfusion was not required in the laparoscopic group and the median volume of blood-transfusion in the open group was 225 ml (0 - 3800 ml). No significant differences were found in intraoperative maximum and minimum blood pressures, maximum and minimum heart rates, systolic blood pressure increased by 30% from the preoperative baseline, systolic blood pressure > or = 200 mm Hg (1 mm Hg = 0.133 kPa), systolic blood pressure < or = 90 mm Hg, incidence of tachycardia (> or = 110 bpm) and bradycardia (< or = 50 bpm) (P > 0.05). And the drainage volume, drainage time, duration in ICU, time to first oral intake and cost of hospitalization were not significantly different between the two groups (P > 0.05). For adrenal pheochromocytoma with maximum diameter of 5 - 10 cm, the laparoscopic procedure decreased operative time, blood loss, blood-transfusion and postoperative hospital stay compared to traditional open surgery. Intraoperative hemodynamic values during laparoscopic adrenalectomy are comparable to those of traditional open surgery. Adrenal pheochromocytoma of 5 - 10 cm is not a contraindication of laparoscopic surgery and experienced urologists can perform it safely for large adrenal pheochromocytoma.