Paraganglioma surgery: Difference between revisions

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==Surgery==
==Surgery==
*Paraganglioma is treated by [[surgical]] excision.  
*Paraganglioma is treated by [[surgical]] excision.  
*Careful pre-operative preparation is required in order to prevent an intra-operative [[hypertensive crisis]], due to the massive release of [[catecholamine]] with tumor handling, or profound post-operative [[hypotension]] and massive fluid requirements resulting from the fluid shifts that follow [[catecholamine]] control.  
*Careful pre-operative preparation is required in order to prevent an intra-operative [[hypertensive crisis]] in the case of catecholamine-secreting paragangliomas, due to the massive release of [[catecholamine]] with tumor handling, or profound post-operative [[hypotension]] and massive fluid requirements resulting from the fluid shifts that follow [[catecholamine]] control.  
*Pre-operative preparation is best undertaken with administration of [[alpha-blocker|alpha-adrenergic blocking agents]], such as [[phenoxybenzamine]].<ref name=surgwiki>Tumours of the adrenal gland. SurgiWiki (2015). http://www.surgwiki.com/wiki/Tumours_of_the_adrenal_gland Accessed on September 23, 2015.</ref>
*Pre-operative preparation is best undertaken with administration of [[alpha-blocker|alpha-adrenergic blocking agents]], such as [[phenoxybenzamine]].<ref name=surgwiki>Tumours of the adrenal gland. SurgiWiki (2015). http://www.surgwiki.com/wiki/Tumours_of_the_adrenal_gland Accessed on September 23, 2015.</ref>
===Operative Management===
===Operative Management===

Revision as of 15:48, 23 September 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

Surgery is the mainstay of treatment for paraganglioma. Pre-operative preparation is best undertaken with administration of alpha-adrenergic blocking agents, such as phenoxybenzamine.

Surgery

Operative Management

  • Adrenalectomy can be performed either as an open procedure, as a laparoscopic procedure with hand assist devices, or solely as a laparoscopic procedure.
  • Increasingly, the accepted philosophy is to tailor the surgical approach to the tumor size and clinical situation.
  • The open approach to the adrenal gland is either anteriorly through the peritoneal cavity (now used only for large and probably malignant lesions), or via an extraperitoneal approach, either posteriorly through the bed of the 12th rib or postero-laterally, or combined as a thoraco-abdominal procedure. These procedures should be used for very large tumors, or those known to be malignant.
  • Laparoscopic adrenalectomy is associated with reduced post-operative pain, and allows the patient to leave hospital after 2 or 3 days.[1]

Complications of Surgery

References

  1. 1.0 1.1 1.2 Tumours of the adrenal gland. SurgiWiki (2015). http://www.surgwiki.com/wiki/Tumours_of_the_adrenal_gland Accessed on September 23, 2015.

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