NEW YORK (Reuters Health) - Most patients with familial pheochromocytomas can be safe and effectively managed with a laparoscopic approach to their adrenal disease, according to a recent report.

Dr. L. Michael Brunt and colleagues, from Washington University in St. Louis, assessed the outcomes of 21 patients with familial pheochromocytomas who underwent adrenalectomy at their institution between December 1993 and July 2001. With the exception of one patient who had undergone previous adrenal surgery and also had a megacolon, a laparoscopic approach was attempted in all patients.

The researchers' findings are published in the May issue of the Annals of Surgery.

The number of right and left adrenalectomies were comparable and, in two patients, bilateral adrenalectomies were performed, the authors note. Two patients required conversion to open adrenalectomy; one because of minor bleeding that obscured visualization and the other due to disruption of the capsule near the tumor.

Fifteen patients experienced intraoperative hypertension, but it was easily controlled with antihypertensive agents. On average, the procedure took 216 minutes and patients were hospitalized for 3.1 days postoperatively. The average tumor size was 3.1 cm.

No perioperative deaths occurred, but two patients did experience major complications. These included a urethral injury from a urinary catheter and a trocar site hernia. No long-term complications related to hypertension or adrenalectomy have been observed.

During an average follow-up period of 57 months, four patients developed a pheochromocytoma in the contralateral adrenal gland. In three patients, the gland was successfully removed laparoscopically. In the fourth, the adrenal mass was asymptomatic and is currently being followed.

"This study is the largest series of patients with familial pheochromocytoma undergoing adrenalectomy during the laparoscopic era," the researchers point out. "The results suggest that the laparoscopic approach is safe and effective for managing unilateral or bilateral adrenal medullary disease in this population."

Ann Surg 2002;235:713-721.

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