Should We Hesitate to Perform Laparoscopic Adrenalectomy for Pheochromacytomas Larger Than 5 cm in Diameter with No Pre-Operative Suspicious Criteria for Malignancy?

Objectives: We aimed to compare the outcomes of patients who underwent laparoscopic adrenalectomy (LA) for pheochromacytoma (PHE) ≥5 cm versus <5 cm in diameter.
Methods: Demographic variables, tumor characteristics, perioperative, and post-operative outcomes were evaluated retrospectively and compared between groups.
Results: Between February 2008 and August 2020, 54 patients (27 female and 27 male) enrolled to the study and divided into two groups according to the tumor size as group L ≥5 cm (28 patients) and group S as <5 cm (26 patients). Groups compared in the aspect of American Society of Anesthesiologists scores, body mass index, tumor locations, ratio of elder (≥60-years-old) patients, and gender ratio were similar between groups S and L (p=0.572, p=0.516, p=0.6, p=0.331, and p=0.207, respectively). Mean duration of surgery (p=0.266), mean estimated blood loss (p=0.587), and mean length of hospital stay (p=0.374) were similar between groups. Difference between maximum and pre-operative systolic pressure and the difference between maximum and pre-operative diastolic pressure were similar between S and L groups (p=0.852 and p=0.526, respectively). Patients whose systolic blood pressure >160 mmHg, systolic blood pressure >30% of baseline, and heart rate >110 (p=0.307, p=0.609, and p=0.296) were similar. Diastolic blood pressure <30%, there is a difference between groups in favor of group L, but not statistically different (p=0.077).
Conclusion: It is necessary to work in coordination with endocrinologists and anesthesiologists and LA for PHE should be performed in experienced medical centers regardless of tumor size with multidisciplinary approach.

Çapý 5 cm'den Büyük Malignite Þüphesi Olmayan Feokromasitomalara Laparoskopik Adrenalektomi Yapmakta Tereddüt Etmeli miyiz?

AMAÇ: Feokromositoma tanýsýyla laparoskopik adrenalektomi yapýlan ≥5 cm ve <5 cm adrenal kitlesi olan hastalarýn sonuçlarýný karþýlaþtýrmayý amaçladýk.
YÖNTEM: Demografik deðiþkenler, tümör özellikleri, perioperatif ve postoperatif sonuçlar retrospektif olarak deðerlendirildi ve gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Þubat 2008 ve Aðustos 2020 tarihleri arasýnda 54 hasta (27 kadýn, 27 erkek) çalýþmaya dahil edildi ve tümör boyutuna göre grup L ≥5 cm (28 hasta) ve grup S <5 cm ( 26 hasta) olarak iki gruba ayrýldý. ASA skorlarý, vücut kitle indeksi, tümör lokasyonlarý, yaþlý (≥ 60 yaþ) hasta oraný ve cinsiyet oraný açýsýndan S ve L gruplarý benzerdi (p = 0,572, p = 0,516, p = 0,6, p = 0.331, p = 0.207, sýrasýyla). Ortalama ameliyat süresi (p = 0.266), ortalama tahmini kan kaybý (p = 0.587), ortalama hastanede kalýþ süresi (p = 0.374) gruplar arasýnda benzerdi. Maksimum ve preoperatif sistolik basýnç farký, maksimum ve preoperatif diyastolik basýnç farký, S ve L gruplarý arasýnda benzerdi (sýrasýyla, p = 0.852 ve p = 0.526). Sistolik kan basýncý> 160 mmHg, sistolik kan basýncý baþlangýc deðerine göre % 30 dan fazla artanlarýn oraný, Kalp hýzý> 110 olanlarýn oranlarý (p = 0,307, p = 0,609, p = 0,296) benzerdi. Diyastolik kan basýncý baþlangýç deðerine göre en az 10 epizotta % 30 dan fazla düþenlerin oranlarý L grubunda daha fazla olmakla birlikte istatistiksel olarak farklý deðildi (p = 0,077).
SONUÇ: Feokromasitoma hastalarýnýn hazýrlýðýnda endokrinologlar ve anestezistler ile koordineli olarak çalýþmalýdýr. Feokromasitoma tedavisinde laparoskopik adrenalektomi tümör boyutundan baðýmsýz olarak multidisipliner yaklaþým ile deneyimli merkezlerde uygulanmalýdýr. (SETB-2021-03-084)