Skip to main content
main-content
Erschienen in: Surgical Endoscopy 8/2015

01.08.2015

Posterior retroperitoneoscopic versus laparoscopic adrenalectomy in sporadic and MENIIA pheochromocytomas

verfasst von: Andreas Kiriakopoulos, Athanassios Petralias, Dimitrios Linos

Erschienen in: Surgical Endoscopy | Ausgabe 8/2015

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Retroperitoneal adrenalectomy (PRA) comprises an alternative approach in the management of adrenal tumors that has been set as the treatment of choice in our Institution. We assess the impact of PRA the management of hereditary and sporadic pheochromocytomas comparing its outcomes to the laparoscopic technique, in a case–controlled setting.

Patients and methods

From May 2008 to January 2013, 17 patients [5 males and 12 females, mean age: 51 yrs (range 26–73)] with pheochromocytomas underwent PRA. Demographics, tumor characteristics, operative time, complications, hospital stay, and postoperative pain (based on VAS score at days 1 and 3) were compared to 17 selected laparoscopic patient controls [7 males and 10 females, mean age 49 yrs (range 25–64)].

Results

17 patients, 11 with the sporadic form and 6 with MENIIA associated pheochromocytomas, comprised the retroperitoneoscopic group. 19 pheochromocytomas with a mean size 3.7 cm (range 1.7–7.0) at a mean operative time: 105.6 min (range 60–180) were accordingly excised. In the laparoscopic group, 13 patients had sporadic pheochromocytomas, whereas 4 patients had MENIIA syndrome. Mean tumor size of the laparoscopic series was 5.1 cm (range 1.7–8.5) at a mean operative time of 137 min (range 75–195). No mortality or conversions were encountered in both groups. No blood transfusions were needed. Mean visual analog scale pain scores were significantly lower for the retroperitoneoscopic group both on days 1 and 3 [0.94 (0–3) vs 4.15 (3–6), p < 0.001 and 0.06 (0–1) vs 3.5 (2–6) p < 0.001] respectively. Mean hospital stay for the patients of the retroperitoneoscopic group was significantly better than the laparoscopic group [(2.1 ± 0.24 days vs 40 ± 0.70 days) p < 0.001].

Conclusions

Retroperitoneoscopic adrenalectomy is associated with excellent clinical results in the management of sporadic and hereditary pheochromocytomas. Moreover, it appears to be superior to the laparoscopic approach, because it is faster and affords the patient with less pain and shorter hospital stay.
Literatur
1.
Zurück zum Zitat Kiriakopoulos A, Economopoulos KP, Poulios E, Linos D (2011) Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift. Surg Endosc 25(11):3584–3589 PubMedCrossRef Kiriakopoulos A, Economopoulos KP, Poulios E, Linos D (2011) Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift. Surg Endosc 25(11):3584–3589 PubMedCrossRef
2.
Zurück zum Zitat Walz MK, Alesina PF, Wenger FA et al (2006) Posterior retroperitoneoscopic adrenalectomy-results of 560 procedures in 520 patients. Surgery 140(6):943–948 PubMedCrossRef Walz MK, Alesina PF, Wenger FA et al (2006) Posterior retroperitoneoscopic adrenalectomy-results of 560 procedures in 520 patients. Surgery 140(6):943–948 PubMedCrossRef
3.
Zurück zum Zitat Constantinides VA, Christakis I, Touska P, Palazzo FF (2012) Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg 99(12):1639–1648 PubMedCrossRef Constantinides VA, Christakis I, Touska P, Palazzo FF (2012) Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg 99(12):1639–1648 PubMedCrossRef
4.
Zurück zum Zitat Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2013) Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 153(1):111–119 PubMedCrossRef Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2013) Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 153(1):111–119 PubMedCrossRef
5.
Zurück zum Zitat Chen W, Li F, Chen D, Zhu Y, He C, Du Y, Tan W (2013) Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutan Tech 23(2):121–127 PubMedCrossRef Chen W, Li F, Chen D, Zhu Y, He C, Du Y, Tan W (2013) Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutan Tech 23(2):121–127 PubMedCrossRef
6.
Zurück zum Zitat Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, Moinzadeh A, Ukimura O, Desai MM, Kaouk J, Bravo E (2005) Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol 174(2):442–445 PubMedCrossRef Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, Moinzadeh A, Ukimura O, Desai MM, Kaouk J, Bravo E (2005) Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol 174(2):442–445 PubMedCrossRef
7.
Zurück zum Zitat Hanssen WE, Kuhry E, Casseres YA, de Herder WW, Steyerberg EW, Bonjer HJ (2006) Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg 93(6):715–719 PubMedCrossRef Hanssen WE, Kuhry E, Casseres YA, de Herder WW, Steyerberg EW, Bonjer HJ (2006) Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg 93(6):715–719 PubMedCrossRef
8.
Zurück zum Zitat Pacak K, Linehan WM, Eisenhofer G et al (2001) Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytomas. Ann Intern Med 134(4):315–329 PubMedCrossRef Pacak K, Linehan WM, Eisenhofer G et al (2001) Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytomas. Ann Intern Med 134(4):315–329 PubMedCrossRef
9.
Zurück zum Zitat Fishbein L, Orlowski R, Cohen D (2013) Pheochromocytoma/Paraganglioma: review of perioperative management of blood pressure and update on genetic mutations associated with pheochromocytoma. J Clin Hypertens 15(6):428–434 CrossRef Fishbein L, Orlowski R, Cohen D (2013) Pheochromocytoma/Paraganglioma: review of perioperative management of blood pressure and update on genetic mutations associated with pheochromocytoma. J Clin Hypertens 15(6):428–434 CrossRef
10.
Zurück zum Zitat Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A (2009) Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 146:621–625 PubMedCrossRef Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A (2009) Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 146:621–625 PubMedCrossRef
11.
Zurück zum Zitat Terachi T, Yoshida O, Matsuda T, Orikasa S, Chiba Y, Takahashi K, Takeda M, Higashihara E, Murai M, Baba S, Fujita K, Suzuki K, Ohshima S, Ono Y, Kumazawa J, Naito S (2000) Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: a multi-institutional study. Biomed Pharmacother 54(suppl1):211s–214s PubMedCrossRef Terachi T, Yoshida O, Matsuda T, Orikasa S, Chiba Y, Takahashi K, Takeda M, Higashihara E, Murai M, Baba S, Fujita K, Suzuki K, Ohshima S, Ono Y, Kumazawa J, Naito S (2000) Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: a multi-institutional study. Biomed Pharmacother 54(suppl1):211s–214s PubMedCrossRef
12.
Zurück zum Zitat Ramacciatto G, Nigri GR, Petrucciani N, Di Santo V, Piccoli M, Buvina P, Valabrega S, D’ Angelo F, Aurello P, Mercantini P, Del Gaudio M, Melloti G (2011) Minimally invasive adrenalectomy: a multicenter comparison of transperitoneal and retroperitoneal approaches. Am Surg 77:409–416 Ramacciatto G, Nigri GR, Petrucciani N, Di Santo V, Piccoli M, Buvina P, Valabrega S, D’ Angelo F, Aurello P, Mercantini P, Del Gaudio M, Melloti G (2011) Minimally invasive adrenalectomy: a multicenter comparison of transperitoneal and retroperitoneal approaches. Am Surg 77:409–416
13.
Zurück zum Zitat Lezoche E, Guerrieri M, Feliciotti F, Paganini AM, Perretta S, Baldarelli M, Bonjer J, Miccoli P (2002) Anterior, lateral, and posterior approaches in endoscopic adrenalectomy. Surg Endosc 16:96–99 PubMedCrossRef Lezoche E, Guerrieri M, Feliciotti F, Paganini AM, Perretta S, Baldarelli M, Bonjer J, Miccoli P (2002) Anterior, lateral, and posterior approaches in endoscopic adrenalectomy. Surg Endosc 16:96–99 PubMedCrossRef
14.
Zurück zum Zitat Gockel I, Vetter G, Heintz A, Junginger T (2005) Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course. Surg Endosc 19:1086–1092 PubMedCrossRef Gockel I, Vetter G, Heintz A, Junginger T (2005) Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course. Surg Endosc 19:1086–1092 PubMedCrossRef
15.
Zurück zum Zitat Naya Y, Nagata M, Ichikawa T, Amakasu M, Omura M, Nishikawa T, Yamakuchi K, Ito H (2002) Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches. BJU Int 90:199–204 PubMedCrossRef Naya Y, Nagata M, Ichikawa T, Amakasu M, Omura M, Nishikawa T, Yamakuchi K, Ito H (2002) Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches. BJU Int 90:199–204 PubMedCrossRef
16.
Zurück zum Zitat Gagner M, Breton G, Pharand D, Pomp A (1996) Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery 120:1076–1079 PubMedCrossRef Gagner M, Breton G, Pharand D, Pomp A (1996) Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery 120:1076–1079 PubMedCrossRef
17.
Zurück zum Zitat Kim AW, Quiros RM, Maxhimer JB, El-Ganzouri AR, Prinz RA (2004) Outcome of laparoscopic adrenalectomy for pheochromocytomas vs aldosteronomas. Arch Surg 139:526–529 PubMedCrossRef Kim AW, Quiros RM, Maxhimer JB, El-Ganzouri AR, Prinz RA (2004) Outcome of laparoscopic adrenalectomy for pheochromocytomas vs aldosteronomas. Arch Surg 139:526–529 PubMedCrossRef
Metadaten
Titel
Posterior retroperitoneoscopic versus laparoscopic adrenalectomy in sporadic and MENIIA pheochromocytomas
verfasst von
Andreas Kiriakopoulos
Athanassios Petralias
Dimitrios Linos
Publikationsdatum
01.08.2015
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 8/2015
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3912-0

Weitere Artikel der Ausgabe 8/2015

Surgical Endoscopy 8/2015 Zur Ausgabe

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.