Retroperitoneal Laparoscopic Adrenalectomy Versus Open Adrenalectomy For The Adrenal Pheochromocytoma

Objective:To evaluate the technical feasibility and outcomes of retroperitoneal laparoscopic adrenalectomy (RLA) versus open adrenalectomy (OA) for the adrenal pheochromocytoma.Method:Between January2009and January2012, a retrospective review of a series of patients (n=37) who underwent RLA was performed and compared with a similar cohort (n=36) that underwent OA for the adrenal pheochromocytoma at our institution. There are not statistical difference on the age [(45.7±10.8) years old vs (47.1±14.0) years old,t=0.390, P=0.696], the maximum diameter of tumor [(5.5±1.5)cm vs(5.9±1.5)cm, t=0.921, P=0.362] and other parameters between the two groups. Demographic, intraoperative, postoperative, and intermediate-term follow-up data were compared between the two groups. Results:The mean operative time [(105.6±68.5)min vs (159.8±54.1)min,(t=3.308, P=0.004)], the estimated blood loss [(108.1±112.7)ml vs (229.3±174.8)ml,(t=2.856, P=0.006)], the postoperative induced flow [(229.3±174.8)ml,(t=2.856, P=0.006) vs (174.4±99.7)ml,(t=3.793, P=0.000)], passage time of gas by anus [(32.4±19.7)h vs (59.0±29.9)h, t=3.642,P=0.001] and hospital stays [(7.8±2.4)d vs (9.3±2.1)d, t=2.433, P=0.019] of PLA group were better than those of OA group. The cases of drastic blood pressure fluctuation in operation (5cases vs14cases, χ2=6.102, P=0.017), the cases requiring blood transfusions (1case vs8cases,χ2=6.432, P=0.014), the incidence of systemic inflammatory response syndrome (SIRS)(6cases vs15cases, χ2=5.768, P=0.021), operative complications (2cases vs9cases,χ2=5.474, P=0.024) of PLA group were significantly lower than those of OA group. During the follow-up of3-36month, there was no tumor recurrence in both groups. The blood pressure of28patients (90.3%) recover to the normal level in the RLA group and26cases (89.7%) in the OA group such that there was not statistical difference.Conclusion:Retroperitoneal laparoscopic. adrenalectomy for the adrenal pheochromocytoma could partly replace open adrenalectomy. Retroperitoneal laparoscopic adrenalectomy is a safety and effective technique even in patients with tumors>6cm and clear boundary. When compared with open adrenalectomy for the adrenal pheochromocytoma, the laparoscopic retroperitoneal technique leads to reduced operating times, potentially less postoperative pain, faster recovery.