Pheochromocytoma surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Surgery is the mainstay of treatment for pheochromocytoma. Adrenalectomy | Surgery is the mainstay of treatment for pheochromocytoma. [[Adrenalectomy]], [[laparoscopic]] transabdomina<nowiki/>l and [[retroperitoneal]] approaches have been used successfully for non-[[metastatic]] [[abdominal]] pheochromocytomas. The patient should receive [[glucocorticoid]] coverage in bilateral [[adrenalectomy]]. | ||
==Surgery== | ==Surgery== | ||
*Surgical [[resection]] of pheochromocytoma is the treatment of choice for [[benign]] localized tumor. | *Surgical [[resection]] of pheochromocytoma is the treatment of choice for [[benign]] localized [[tumor]]. | ||
*Patients with unilateral pheochromocytoma should undergo unilateral adrenalectomy, patients with bilateral pheochromocytomas or who develop pheochromocytoma in their remaining adrenal gland should undergo cortical-sparing adrenalectomy.<ref name="pmid8957496">{{cite journal| author=Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC| title=Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. | journal=Surgery | year= 1996 | volume= 120 | issue= 6 | pages= 1064-70; discussion 1070-1 | pmid=8957496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8957496 }}</ref> It may also be necessary to perform a complete surgical [[resection]] of the affected adrenal gland. | *Patients with unilateral pheochromocytoma should undergo unilateral [[adrenalectomy]], patients with bilateral pheochromocytomas or who develop pheochromocytoma in their remaining [[adrenal gland]] should undergo cortical-sparing [[adrenalectomy]].<ref name="pmid8957496">{{cite journal| author=Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC| title=Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. | journal=Surgery | year= 1996 | volume= 120 | issue= 6 | pages= 1064-70; discussion 1070-1 | pmid=8957496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8957496 }}</ref> It may also be necessary to perform a complete surgical [[resection]] of the affected [[adrenal gland]]. | ||
=== '''Adrenalectomy:''' === | === '''Adrenalectomy:''' === | ||
*[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and retroperitoneal approaches have been used successfully for | *[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and [[retroperitoneal]] approaches have been used successfully for non-[[Metastasis|metastatic]] [[abdominal]] pheochromocytomas.<ref name="pmid21494137">{{cite journal| author=Nehs MA, Ruan DT| title=Minimally invasive adrenal surgery: an update. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2011 | volume= 18 | issue= 3 | pages= 193-7 | pmid=21494137 | doi=10.1097/MED.0b013e32834693bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494137 }}</ref> | ||
* | *There are less complications associated with [[laparoscopic surgery]] than with [[open surgery]]. [[Catecholamine]] secretion falls to a normal level within a week. | ||
*Major intraoperative complications include intraoperative tumor capsule rupture, hypertensive crisis, myocardial infarctions, or cerebrovascular hemorrhages. | *Major intraoperative complications include intraoperative [[tumor]] capsule rupture, [[hypertensive crisis]], [[myocardial infarctions]], or [[Stroke|cerebrovascular hemorrhages]]. Hemodynamic instability after [[tumor]] resection is possible. [[Hypoglycemia]] can occur after tumor resection due to unopposed [[insulin]] effect after declining of [[catecholamines]] levels.<ref name="pmid25188716">{{cite journal| author=Rafat C, Zinzindohoue F, Hernigou A, Hignette C, Favier J, Tenenbaum F et al.| title=Peritoneal implantation of pheochromocytoma following tumor capsule rupture during surgery. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 12 | pages= E2681-5 | pmid=25188716 | doi=10.1210/jc.2014-1975 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25188716 }}</ref> | ||
*Severe [[hypotension]] can occur after removal of the gland due to decreased catecholamines level in blood and [[downregulation|down-regulation]] of [[adrenergic receptors]]. It can be controlled by [[vasopressors]] induction.<ref name="pmid14734011">{{cite journal| author=Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P| title=Laparoscopic surgery for pheochromocytoma. | journal=Eur Urol | year= 2004 | volume= 45 | issue= 2 | pages= 226-32 | pmid=14734011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14734011 }}</ref> | *Severe [[hypotension]] can occur after removal of the gland due to decreased [[catecholamines]] level in [[blood]] and [[downregulation|down-regulation]] of [[adrenergic receptors]]. It can be controlled by [[vasopressors]] induction.<ref name="pmid14734011">{{cite journal| author=Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P| title=Laparoscopic surgery for pheochromocytoma. | journal=Eur Urol | year= 2004 | volume= 45 | issue= 2 | pages= 226-32 | pmid=14734011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14734011 }}</ref> | ||
*Risk factors for complications during surgery: | *Risk factors for complications during surgery include: | ||
*The patient should receive glucocorticoid stress coverage in bilateral adrenalectomy. | **High [[plasma]] [[norepinephrine]] concentration | ||
**Larger [[tumor]] size | |||
**[[Postural hypotension]] after [[Alpha blocker|α-blockade]], and a [[mean arterial pressure]] above 100 mm Hg. | |||
*The patient should receive [[glucocorticoid]] stress coverage in bilateral [[adrenalectomy]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 16:44, 16 August 2017
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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] Mohammed Abdelwahed M.D[3]
Overview
Surgery is the mainstay of treatment for pheochromocytoma. Adrenalectomy, laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytomas. The patient should receive glucocorticoid coverage in bilateral adrenalectomy.
Surgery
- Surgical resection of pheochromocytoma is the treatment of choice for benign localized tumor.
- Patients with unilateral pheochromocytoma should undergo unilateral adrenalectomy, patients with bilateral pheochromocytomas or who develop pheochromocytoma in their remaining adrenal gland should undergo cortical-sparing adrenalectomy.[1] It may also be necessary to perform a complete surgical resection of the affected adrenal gland.
Adrenalectomy:
- Laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytomas.[2]
- There are less complications associated with laparoscopic surgery than with open surgery. Catecholamine secretion falls to a normal level within a week.
- Major intraoperative complications include intraoperative tumor capsule rupture, hypertensive crisis, myocardial infarctions, or cerebrovascular hemorrhages. Hemodynamic instability after tumor resection is possible. Hypoglycemia can occur after tumor resection due to unopposed insulin effect after declining of catecholamines levels.[3]
- Severe hypotension can occur after removal of the gland due to decreased catecholamines level in blood and down-regulation of adrenergic receptors. It can be controlled by vasopressors induction.[4]
- Risk factors for complications during surgery include:
- High plasma norepinephrine concentration
- Larger tumor size
- Postural hypotension after α-blockade, and a mean arterial pressure above 100 mm Hg.
- The patient should receive glucocorticoid stress coverage in bilateral adrenalectomy.
References
- ↑ Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC (1996). "Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma". Surgery. 120 (6): 1064–70, discussion 1070-1. PMID 8957496.
- ↑ Nehs MA, Ruan DT (2011). "Minimally invasive adrenal surgery: an update". Curr Opin Endocrinol Diabetes Obes. 18 (3): 193–7. doi:10.1097/MED.0b013e32834693bf. PMID 21494137.
- ↑ Rafat C, Zinzindohoue F, Hernigou A, Hignette C, Favier J, Tenenbaum F; et al. (2014). "Peritoneal implantation of pheochromocytoma following tumor capsule rupture during surgery". J Clin Endocrinol Metab. 99 (12): E2681–5. doi:10.1210/jc.2014-1975. PMID 25188716.
- ↑ Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P (2004). "Laparoscopic surgery for pheochromocytoma". Eur Urol. 45 (2): 226–32. PMID 14734011.