Safty And Efficacy Analysis Of Laparoscopic Adrenalectomy For Large Adrenal Phreochromocytoma

Background and Purpose:Pheochromocytoma is one of the most common tumors source from adrenal medulla.Surgical intervention has been the only choice to cure adrenal pheochromocytoma,The adrenal glands are paired structures located adjacent to the liver,pancreas,kidneys and major vessels. Intraoperative squeezing and traction of the tumor may cause instant flutter of the blood pressure and even life-thraetening complications as heart failure, pulmonary edema or cranial hemorrhage,etc.Hence the resection of pheochromocytoma,especially for larger ones(maximum diameter> 6cm),has been categorized as one of the most challenging procedures by urologists. Since Gagner M [1] first report in 1992, laparoscopic adrenalectomy,laparoscopic adrenalectomy has increasingly become the "Goldern Standerd" for adrenalectomy[2].Though it was once controversial,the safty and efectiveness of laparoscopic resection for chromocytoma has been recognized by most physicians with the development of surgical and anesthesiologic technique.But it remains controversial for adrenal pheochromocytoma in large volumes.We retrospectively analysed the cases of lager volume pheochromocytoma which underwent laparoscopic procedure and evaluated it safty and effectiveness.Methods1. Cases and exclusion criteria included:(1) included standardsThe selective cases only include in adrenal pheochromocytoma which prove by pathology postoperative.and the maximum diameter of tumor>6cm(2) The exclusion criteriaDuring surgery at the same time.rule out these who under the surgery that co-operate with other clinic departments such as general surgery, gynecology surgery, Rule out other serious diseases may affect the process of treatment and patients in order to avoid the interference of the statistical data.2. Case collectionBetween January 2005 to January 2010, clinical data were respectively obtained on SRRSH's 10 consecutive cases of LA (the additional 1 cases were converted to open surgery and were excluded) and 6 OA. We gathered the detailed clinic data with these patients, including detail record of the name, gender, age, home address, telephone number, main complaint, tumor size, diagnosis, operative methods, date of surgery, amount of blood loss, intraoperative maximum and minimum blood pressures, length of the incision, short time postoperative complications, the hospital stay after operation, B-ultrasound and CT or MRI results, etc.3. Data analysis:We evaluated the role of the LA in contrast to OA for large adrenal pheochromocytoma by analyzing the data of the gender, age, tumor size, blood loss,short time postoperative complications, intraoperative maximum and minimum blood pressures,length of the incision,length of stay after operation etc. All the data were analyzed by SPSS 16.0 for Windows. We choseχ2-test and independent t-test statistical methods depended on the different data information.Results Adrenal pheochromocytoma was confirmed by pathology postoperatively for all cases. There was no difference in tumor size, where 4cases were on the left and 12 on the right. All patients have no metastasis with follow-up of 5 to 25 months.Significant difference of Intraoperative blood loss was appreciated between the 2 groups (mean 305ml for LA, 566ml for OA respectively, P< 0.05). The mean hospital stay for LA and OA was 5.1 and 10 days respectively. (P<0.05). Four patients (40%) underwent LA experienced intraoperative hypertension (systolic blood pressure>200mmHg), as did 2 cases (33.3%) with the open approach. Three cases (30%) of intraoperative hypotension (systolic blood pressure< 80 mmHg) occurred in LA group, and 2 cases (33.3%) in OA group. Three patients (30%) in LA group and 2 (33.3%) in OA group received inntraoperative and/or postoperative transfusion.No significant difference was found in the incidence of hypertension or hypotension and transfusion rates between the two groups.The incision length of LA (5.3cm) was shorter than that of the OA (5.3cm).Of the 7 patients who had preoperative hypertension,6 recovered postoperatively and 1 patient still needs antihypertensi ves.Conclusion:For large adrenal pheochromocytoma(maximum diameter>6 cm), the laparoscopic procedure decreased blood loss,length of incision and postoperative hospital stay compared to traditional open surgery, large adrenal pheochromocytoma is not a contraindication of laparoscopic surgery, experienced urologists can perform it safely for large adrenal pheochromocytoma.