Pheochromocytoma--continuing evolution of surgical therapy.

BACKGROUND: The management of pheochromocytoma has evolved through refinements in diagnosis, localization, and pharmacologic therapy for hemodynamic control both before and during operation. To provide a benchmark for comparison and to assess the feasibility of surgical resection using a posterior or laparoscopic approach, we reviewed the overall management and outcome of 110 patients who underwent primary resection of pheochromocytoma or paraganglioma between 1980 and January 1992 at the Mayo Clinic.
METHODS: Patient records were reviewed for demographic information, associated conditions, symptoms, laboratory evaluation, localizing techniques, preoperative adrenergic blockade, intraoperative hemodynamics, tumor location, pathologic conditions, and outcome.
RESULTS: The most prominent symptoms included headaches, sweating, and palpitations. Forty-seven percent of patients had sustained hypertension, and classic paroxysmal attacks were present in 72%. The combination of urinary metanephrines and vanillylmandelic acid had a sensitivity of 98% in detecting the disease. The positive and negative predictive values for localization of tumors by computed tomography scan were 95% and 100%, respectively. With routine alpha- and beta-blockade, there were no complications associated with intraoperative hypertension. Perioperative mortality was less than 1% and morbidity was 16%. More than 90% of patients were restored to a condition of normotension; only 20% of these required medication.
CONCLUSIONS: Surgical resection of these tumors, via a transabdominal approach, can be accomplished safely and hospitalization usually extends a week. Today the diagnosis, localization, preoperative blockade, intraoperative hemodynamic control, and postoperative management have reached a level sufficient to permit either a posterior or laparoscopic approach, but only if they can be mastered technically.