Tarin C Worrest1, Erin W Gilbert1, Brett C Sheppard2. 1. Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA. 2. Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA. Electronic address: sheppard@ohsu.edu.
Abstract
BACKGROUND: Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. METHODS: A retrospective review was undertaken of pheochromocytoma adrenalectomy patients between 1997 and 2017. Clinical variables and postoperative complications were recorded. Patients were divided into quartiles for analysis: group 1 from 1997 to 2001, group 2 from 2002 to 2006, group 3 from 2007 to 2011, and group 4 from 2012 to 2017. RESULTS: Eighty-two pheochromocytoma adrenalectomies were identified. The percentage of laparoscopic adrenalectomies increased over time: 60% in group 1-87.5% in group 4 (p = 0.03). The average tumor size decreased: 6.4 cm (2.8-14.3 cm) in group 1-4.6 cm (1.2-7.8 cm) in group 4 (p = 0.03). ICU utilization decreased from 80% to 40.6% (p = 0.03) and length of stay decreased from 7.2 days to 2.7 days (p = 0.005). Clavien-Dindo grade>3 complications did not differ between the quartiles (p = 0.08). CONCLUSION: Pheochromocytoma care has evolved from more open procedures with standard postoperative ICU stay to a laparoscopic resection with targeted ICU care and decreased length of stay. As experience with laparoscopic adrenalectomy increases, patient outcomes improve.
BACKGROUND: Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. METHODS: A retrospective review was undertaken of pheochromocytoma adrenalectomypatients between 1997 and 2017. Clinical variables and postoperative complications were recorded. Patients were divided into quartiles for analysis: group 1 from 1997 to 2001, group 2 from 2002 to 2006, group 3 from 2007 to 2011, and group 4 from 2012 to 2017. RESULTS: Eighty-two pheochromocytoma adrenalectomies were identified. The percentage of laparoscopic adrenalectomies increased over time: 60% in group 1-87.5% in group 4 (p = 0.03). The average tumor size decreased: 6.4 cm (2.8-14.3 cm) in group 1-4.6 cm (1.2-7.8 cm) in group 4 (p = 0.03). ICU utilization decreased from 80% to 40.6% (p = 0.03) and length of stay decreased from 7.2 days to 2.7 days (p = 0.005). Clavien-Dindo grade>3 complications did not differ between the quartiles (p = 0.08). CONCLUSION:Pheochromocytoma care has evolved from more open procedures with standard postoperative ICU stay to a laparoscopic resection with targeted ICU care and decreased length of stay. As experience with laparoscopic adrenalectomy increases, patient outcomes improve.