Laparoscopic adrenalectomy for pheochromocytoma: comparison with conventional open adrenalectomy.

摘要

PURPOSE: To compare the effectiveness and efficacy of laparoscopic transperitoneal adrenalectomy (LTA) with those of open adrenalectomy (OA) in patients with pheochromocytoma. PATIENTS AND METHODS: Among 24 patients (13 male, 11 female) who underwent surgical removal of pheochromocytoma, LTA and OA were performed in 15 and 9, respectively. The mean age was 45.2 years in the LTA group and 43.3 years in the OA group, and the mean tumor size was 5.2 +/- 2.0 (SE) cm and 6.4 +/- 2.6 cm, respectively. Retrospective analysis of their clinical outcomes was performed. The mean follow-up for OA and LTA groups was 36 months and 22 months, respectively. RESULTS: The mean operative time was 171 +/- 66.7 minutes in the LTA group and 200 +/- 73.3 minutes in the OA group. The mean blood loss was 189.5 +/- 50.4 mL and 397.1 +/- 144.7 mL, respectively (P = 0.0341). The mean number of intraoperative hypertensive crises was 0.6 +/- 0.5 during LTA and 1.67 +/- 1.1 during OA (P = 0.0146). In the LTA group, there were no conversions to open surgery and no intraoperative complications, and the blood pressure was well managed intraoperatively without medication. The mean time to oral intake was 1.1 +/- 0.3 days after LTA and 2.6 +/- 1.3 days after OA (P = 0.0037). The mean postoperative hospital stay was 5.6 +/- 2.0 days in the LTA group and 12.4 +/- 3.5 days in the OA group (P = 0.0001). Patient-controlled analgesia was needed by 2 patients (13.3%) in the LTA group and 6 (66.7%) in the OA group (P = 0.0413). In the OA group, three pneumothoraces and one case of sepsis occurred. After a mean follow-up of 36 months, two patients in the OA group redeveloped hypertension. With a mean follow-up of 22 months, none of the 15 LTA patients redeveloped hypertension. CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytoma is a safe and effective prodcedure providing the benefits of a minimally invasive approach.