SIU 2017: Is Laparoscopic Adrenalectomy by Lateral Retroperitoneal Approach Safe and Feasible Treatment Option for Pheochromocytoma Larger than 6cm?

Lisbon, Portugal ( Laparoscopic adrenalectomy for pheochromocytoma is a technically challenging procedure, traditionally approached by a transperitoneal approach. However, as with renal surgery, the retroperitoneal approach offers some benefits, particularly in obese patients. In this study, the group from South Korea examine the feasibility of laparoscopic adrenalectomy via a retroperitoneal approach (LRA) for large pheochromocytomas (PCC). 

This was a single institution retrospective study looking at 51 patients treated with LRA for large PCC. The two groups were split based on PCC size – Group A <= 6 cm (27) or Group B > 6 cm (24). Other than tumor size (preplanned) and urinary metanephrine levels, the two cohorts had similar baseline demographics. Group B had longer operative times, greater blood loss, and hemoglobin change (p <0.05 for all). However, no significant different differences were noted in perioperative complications (only grades 1 and 2 listed) or mortality (unclear what the time frame was). 

As a separate outcome, they also assessed for predictors of developing intraoperative hypertension. On multivariable analysis, symptomatic PCC and baseline tumor size were positive predictors for intraoperative HTN. This was not entirely unexpected.

Based on this simple, small series, they conclude that LRA is safe and effective, even for tumors > 6 cm. 

However, as can be imagined, a series such as this is inherent to significant bias. It is unclear what selection criteria led to these patients being included in the study as opposed to traditional transperitoneal approach. Additionally, though they state that it is effective, they are just comparing LRA against itself – there is no arm for open adrenalectomy or transperitoneal laparoscopic adrenalectomy. As for complications, they only list Grade 1 and 2 complications – what about Grades 3-5? Those are the more important grades on the Clavien-Dindo scale. 

Despite its flaws, laparoscopic retroperitoneal adrenalectomy is technically feasible. Further study is required to state is safe and effective.

Presented by: Ho Seok Chung 

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd, at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal