Laparoscopic Adrenalectomy in the Treatment of Pheochromocytoma: Comparison with Open Approach

Purpose: To compare operative and postoperative parameters after laparoscopic and open surgery in the treatment of adrenal pheochromocytoma. Methods: Electronic and paper charts of 173 patients who underwent surgery for adrenal pheochromocytoma at our institution over a period of 17 years (Jan 1990 May 2007) were reviewed. Perioperative parameters were compared in the two groups. Subgroup analyses were performed for 96 patients identified with lesions > 5 cm. Results: The two groups were similar in terms of age, sex, body mass index (BMI), and American Society of Anesthesiology (ASA) score. The tumors treated by open surgery (6.8 + 3.9 cm) were larger than those treated by laparoscopy (4.5 + 1.95 cm). Mean estimated blood loss (EBL) (801 vs. 140 ml), operating (OR) time (262 vs. 158.5 minutes), length of stay (LOS) in PACU (624 vs.311 minutes), total hospital stay (184 vs. 67.5 hours), morphine requirement (488 vs. 53.5 mg), and time for complete convalescence (109 vs. 23 days) were significantly greater with open surgery. Post-operative complications were seen more often in the open group (25 vs. 20). In the subgroup with lesions > 5 cm, the two groups were similar in terms of age, sex, BMI, and ASA. Mean Blood loss (600 vs. 100 ml), OR time (277 vs. 172 minutes), LOS in PACU (10.9 vs. 6.3 hours), total hospital stay (7.6 vs. 2.9 days), morphine requirement (551 vs. 54 mg), and time for complete convalescence (94 vs. 14 days) were significantly greater with open surgery. Conclusions: Despite the tumor size, laparoscopic surgery is safe and effective in the treatment of adrenal pheochromocytoma due to the advantages of the minimal invasive surgery.