Paraganglioma surgery
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Paraganglioma Microchapters |
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Paraganglioma surgery On the Web |
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American Roentgen Ray Society Images of Paraganglioma surgery |
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. The surgical approach is often tailored to the tumor size and clinical situation.
Surgery
- Paraganglioma is treated by surgical excision.
- 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-adrenergic blocking agents, such as phenoxybenzamine.[1]
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
- Complications of adrenalectomy include all the general complications of any open abdominal adrenal operation or laparoscopic procedure such as bleeding, wound infection and ileus.[1]
References
- ↑ 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.