A Retrospective Study Of The Diagnosis And Treatment Of Pheochromocytoma

Objective: In purpose of evaluation of safety and efficacy in pheochromocyt-omaassociated applications,our study summed up the clinical data in our hospital,making the approaching guideline setting-up possible.Methods: From November 2011 to August 2017,forty-seven cases were underwentpheochromocytoma resection,and were validated by postoperative pathological examination and immunohistochemistry.Data included routine laboratory tests,imaging studies and endocrine-related tests.Routine administration of phenoxybenzamine preoperatively were taken to make blood pressure to meet the surgical criteria,followingplasma volume expansion therapy.By retrospectively analyzing data of clinical manifestations,tumor diameters,operation type and time,intraoperative blood loss,total hospital stayand cost,intraoperative and postoperative complications,and postoperative follow-up respectively,we summarized the characteristics of diagnosis and treatment of pheochromocytoma,which can provide reference for clinical work in the future.Result: There were seventeen males and thirty females with an age of 16-74 years old(45.4 ± 14.4 years old).Seven patients had a history of abdominal surgery.The tumors were located on the right,left and bilateral side(s)among twenty-four,twenty and two cases literally,with one case of lung metastasis.The tumor diameters were 2-13 cm(5.7 ± 2.6 cm).All patients underwent surgical applications,including laparoscopic adrenalectomy in thirty-nine cases,open surgery in seven cases,and thoracoscopic surgery in one case.The operation time was 60-360 min(157.6 ± 75.0 min)with operation bleeding volume 10-8000 ml(510.7 ± 1277.1 ml).The total hospitalization time was 5-34 days(16.9± 5.7 d).The hospitalization cost was 15689-99207 RMB(31483.8 ± 13031.4RMB).Twenty patients with tumor diameter more than 6cm were treated with laparoscopic surgery in thirty cases and open operation in seven cases.Except for the tumor diameter,there was no significant statistic difference between the two groups in terms of operation time,intraoperative blood loss,total hospital stay,and total cost of hospitalization,postoperative hospital stay(P> 0.05).Among the forty patients who underwent laparoscopic surgery,twenty-seven were with tumor diameters less than 6cm,and thirty patients with more than 6cm.Statistical difference was found in tumor diameter,operation time,and intraoperative blood loss between the two groups.The postoperative hospital days and hospitalization costs in the two groups were not statistically different(P> 0.05).Eight of the thirteen patients underwent transperitoneal surgery and five underwent retroperitoneal surgery.Excluding intraoperative blood lossand total hospital expenses,there was no significant statistic difference in tumor diameter,operation time,and total days of hospitalization(P>0.05).All patients underwent follow-up(5-54 months,29.1±15.8months)and no cancer-related deaths were found.Conclusion: Hypertension is the most important clinical manifestation of pheochro-mocytoma.Tumor diameter less than 6cm is the best indication for laparoscopic surgery.By opposite,the endoscopic surgery is relatively safe and feasible.The intraperitoneal or transperitoneal approach can be selected based on the specific conditions of the tumor and surgeon’s experience.Diameter equaling to 8cm is a threshold and risk factor for laparoscopic transit opening surgery,and transabdominal approach is recommended.For tumors with local infiltration or vascular invasion,open surgery is preferable to laparoscopic approach,since it’s the contraindication to the latter one.