Diagnosis And Treatment Of 81 Cases Of Abdominal Paraganglioma

Objective:To investigate clinical characteristics of the primary abdominal paraganglioma,and to summarize the experience of diagnosis and treatment.Materials and methods: The clinical data of 81 patients with primary abdominal paraganglioma treated in the Affiliated Hospital of Qingdao University from December 2001 to December 2016 were retrospectively analyzed.Results: 92.6%(75/81)of tumors were close to or invaded large abdominal vessels,53%(43/81)of cases were functional paraganglioma and 47%(38/81)of its were nonfunctional paraganglioma.Benign and malignant tumors are 79%(64/81)and 21%(17/81),respectively.Complete resection rate was 98.8%(80 / 81),The rate of combined organ resection was 32.1%(26/81).21%(17/81)of patients had violent fluctuation of blood pressure,6.2%(5/81)of cases had the occurrences of low blood pressure.The 3 year and the 5 year survival rates of the patients with retroperitoneal paragonglioma were about 100% and 92%,respectively.The 3 and 5 year recurrence rates are 2.0% and 98.0%,respectively.There was no difference of benign and malignant tumor between the functional group and the non functional group(χ2 =0.31,P=0.58).Patients with functional tumors without preoperative hypertension were more likely to have blood pressure fluctuations during operation(χ2=28.50,P = 0.00).Patients with functional tumors without preoperative hypertension are prone to occur hypotension after the resection of the tumors(χ2=13.05,P=0.000);Preoperative regularly use of phenoxybenzamine can reduce the incidence rate of the occurrence of intraoperative blood pressure fluctuations(P=0.005).There was no significant statistical difference between the functional group and the non functional group in the invasion of the surrounding organs(χ2=1.79,P=0.181).The 3 year and the 5 year survival and recurrence rates of the patients with functional tumors were 100% 、96% and 0% 、9%,respectively.The 3 year and the 5 year survival and recurrence rates of the patients with non functional tumors were 100% 、86%,and 5.0% 、15.0%,respectively.Functional tumors have a better prognosis than non functional tumors(Log-Rank: χ2=3.793,P=0.051,Breslow Test: χ2=4.25,P= 0.039).Non functional tumors are more likely to recur than functional tumors(c2=4.256,P=0.039).Plasma NE and E levels were higher in patients with hypertension than those without hypertension(t=-3.86,P=0.001)、(t=-3.72,P=0.001).Postoperative plasma NE、E decreased compared with preoperative plasma NE、E(t=-3.46,P=0.00)、(t=2.24,P=0.041).The Ki67 of malignant tumor was significantly higher than benign tumor(Z=-6.34,P=0.000).The 3 year and the 5 year survival and recurrence rates of patients with malignant tumor were 100% 、66%and 6% 、47%,respectively.The 3 year and the 5 year survival and recurrence rates of patients with benign tumors were 100% 、96%and 0% 、4%,respectively.The prognosis of benign tumor is good and the prongosis of malignant tumor is poorer than benign tumor(Log-Rank Test: χ2=3.80,P=000).A small range of tumor resection(P=0.0498)is a risk factor for recurrence of malignant tumor;A small range of tumor resection(χ2=0.051,P=0.025),and no functional tumor(χ2=3.996,P=0.046 function)are the factors of poor prognosis of malignant tumor.Multivariate analysis : A small range of tumor resection(P=0.043)was significant risk factors for the prognosis of malignant tumor.Conclusion: Paraganglioma often occurs beside the large retroperitoneal vessels and is likely to occur blood pressure fluctuations during operation.Blood pressure fluctuations occur easily in functional tumors without hypertension.Hypotension were more likely to occur without preoperative hypertension.The prognosis of functional tumors was better than that of non functional tumors.Plasma levels of NE and E are important in judging the nature of tumor and the effect of operation.So far,there is no clear pathological diagnosis standard of benign and malignant tumors,but Ki-67 plays an important role in judging the benign and malignant tumor.The risk factor of recurrence and prognosis of malignant tumors was a small range of tumor resection.Adequate preoperative preparation is the key to successful operations.A small range of tumor resection was significant risk factors for the prognosis of malignant tumor.For patients without hypertension should also be fully preoperative fluid and taking phenoxybenzamine.Lifelong follow-up is important for postoperative patients,especially for non functional tumors and malignant patients.