Patrick T Gomella1, Thomas H Sanford2, Peter A Pinto1, Gennady Bratslavsky2, Adam R Metwalli3, W Marston Linehan1, Mark W Ball4. 1. Urologic Oncology Branch, National Cancer Institute, Bethesda, MD. 2. Urologic Oncology Branch, National Cancer Institute, Bethesda, MD; Department of Urology, SUNY Upstate Medical University, Syracuse, NY. 3. Urologic Oncology Branch, National Cancer Institute, Bethesda, MD; Division of Urology, Howard University, Washington, DC. 4. Urologic Oncology Branch, National Cancer Institute, Bethesda, MD. Electronic address: mark.ball@nih.gov.
Abstract
OBJECTIVE: To evaluate the recurrence and functional outcomes in a primarily hereditary cohort of patients undergoing partial adrenalectomy for pheochromocytoma. METHODS: A retrospective review from a prospectively managed database of patients undergoing partial adrenalectomy from 1995 to 2018 at the National Cancer Institute was performed. Local recurrence was defined as imaging evidence of a recurrent or de novo lesion on the operative side. Steroid dependency was defined as requiring daily steroid replacement at time of last follow-up. RESULTS: One hundred and twenty-four partial adrenalectomies, removing 162 tumors, were performed in 107 patients. Most patients had a known hereditary predisposition to develop bilateral, multifocal, and recurrent pheochromocytoma. Median tumor size was 2 cm (interquartile range (IQR) 1.5-2.8). Median follow-up was 60 months (IQR 13-131). Local recurrence occurred in 17 patients (15.8%) and were managed with active surveillance or surgery. A single patient (1/106, 0.9%) developed metastatic spread of pheochromocytoma approximately 14 years after his first of 2 partial adrenalectomies and remains alive under active surveillance. Median time to recurrence was 71 months (IQR 26-127) with 10 patients (9.3%) requiring daily steroid replacement at time of last follow-up. CONCLUSION: Partial adrenalectomy offers excellent oncologic and functional outcomes, sparing most patients from lifelong steroid replacement therapy. Recurrences can be easily managed with repeat surgery or active surveillance via functional work-up and imaging. Partial adrenalectomy remains the recommended surgical management for patients pre-disposed to development of bilateral, multifocal and recurrent pheochromocytoma. Published by Elsevier Inc.
OBJECTIVE: To evaluate the recurrence and functional outcomes in a primarily hereditary cohort of patients undergoing partial adrenalectomy for pheochromocytoma. METHODS: A retrospective review from a prospectively managed database of patients undergoing partial adrenalectomy from 1995 to 2018 at the National Cancer Institute was performed. Local recurrence was defined as imaging evidence of a recurrent or de novo lesion on the operative side. Steroid dependency was defined as requiring daily steroid replacement at time of last follow-up. RESULTS: One hundred and twenty-four partial adrenalectomies, removing 162 tumors, were performed in 107 patients. Most patients had a known hereditary predisposition to develop bilateral, multifocal, and recurrent pheochromocytoma. Median tumor size was 2 cm (interquartile range (IQR) 1.5-2.8). Median follow-up was 60 months (IQR 13-131). Local recurrence occurred in 17 patients (15.8%) and were managed with active surveillance or surgery. A single patient (1/106, 0.9%) developed metastatic spread of pheochromocytoma approximately 14 years after his first of 2 partial adrenalectomies and remains alive under active surveillance. Median time to recurrence was 71 months (IQR 26-127) with 10 patients (9.3%) requiring daily steroid replacement at time of last follow-up. CONCLUSION: Partial adrenalectomy offers excellent oncologic and functional outcomes, sparing most patients from lifelong steroid replacement therapy. Recurrences can be easily managed with repeat surgery or active surveillance via functional work-up and imaging. Partial adrenalectomy remains the recommended surgical management for patients pre-disposed to development of bilateral, multifocal and recurrent pheochromocytoma. Published by Elsevier Inc.
Authors: Elizabeth G Grubbs; Thereasa A Rich; Chaan Ng; Priya R Bhosale; Camilo Jimenez; Douglas B Evans; Jeffrey E Lee; Nancy D Perrier Journal: J Am Coll Surg Date: 2013-02 Impact factor: 6.113
Authors: R R Perry; H R Keiser; J A Norton; R T Wall; C N Robertson; W Travis; H I Pass; M M Walther; W M Linehan Journal: Ann Surg Date: 1990-11 Impact factor: 12.969
Authors: Thomas Sanford; Patrick T Gomella; Rashid Siddiqui; Daniel Su; Julie Y An; Gennady Bratslavsky; Mark W Ball; W Marston Linehan; Adam R Metwalli Journal: Urol Oncol Date: 2020-12-08 Impact factor: 2.954