Roentgenendovascular occlusion of the suprarenal gland vessels as a method of prophylaxis of complications in laparoscopic adrenalectomy for pheochromocytoma


Keywords: pheochromocytoma; laparoscopy; roentgenendovascular selective electrocoagulation occlusion; аdrenalectomy; hemodynamical instability

Abstract

Objective. To estimate the results of application of roentgenendovascular selective electrocoagulation occlusion of the suprarenal gland vessels (RSEO) in treatment of pheochromocytoma.

Маterials and methods. Prospective and retrospective investigation of the treatment results in 66 patients, in whom laparoscopic adrenalectomy (LА) for pheochromocytoma was conducted in 2008 - 2018 yrs, was accomplished. For comparative analysis the patients were distributed into two Groups: Group I - 36 patients, in whom 24 h before LA the RSEO of the suprarenal gland vessels was conducted, while in Group II - 30 patients, in whom LA only was performed. Average duration of operative intervention, the blood loss volume, parameters of hemodynamics, level of metanephrine in urine and complications were analyzed.

Results. The Groups did not differ essentially by the age and gender of patients, localization and dimensions of the tumor. The volume of intraoperative blood loss in patients of Group I have constituted (50 ± 5.78) ml, Group II - (105.48 ± 84.41) ml (p < 0.00001). While hospitalization the average level of metanephrine in urine in patients of Group I and Group II practically did not differ - (1163.54 ± 931.5) mcg/24 h (153.0 - 4011.0 mcg/24 h) and (1097.69 ± 903.28) mcg/24 h (146.5 - 3350 mcg/24 h) accordingly (р=0.254), but in 24 h after RSEO of the suprarenal glands vessels the average level of metanephrine in urine in the Group I patients have reduced essentially and constituted (315.64 ± 111.51) mcg/24 h (108 - 614.51 mcg/24 h, р=0.00001). Duration of operative intervention in patients of Group I and Group II was quite similar - accordingly (110.8 ± 44.88) and (113.3 ± 55.42) min (p = 0.515). Hemodynamical instability was observed only in 5 (16,7%) patients of Group II. Complications have occurred in 4 (13.3%) patients of Group II and in 1 (2.8%) patient of Group I. Lethality in both groups was absent.

Conclusion. In comparison with LA, multidisciplinary approach evolves more secure, rapid and effective in treatment of patients, suffering pheochromocytoma.

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Author Biographies


A. V. Skums, Shalimov National Institute of Surgery and Transplantology, Kyiv

AnatoliY Skums, MD, DSci (Med)
Surgeon oncologist, Chief of Department of combined pathology and retroperitoneal surgery,
Shalimov National Institute of Surgery and Transplantology,
Address: 30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine, tel.: +38 (044)4542079
email: skums.av@gmail.com
ORCHID: https://orcid.org/0000-0002-2350-6245


A. E. Kovalenko, Коmisarenko Іnstitute of Endocrinology and Metabolism of Substances, Kyiv

Andriy Kovalenko, MD, PhD
Chief of Department
Endocrine surgeon, Department of endocrine surgery,
Komisarenko Institute of Endocrinology and Metabolism,
Adress: Vyshgorodska Str., 69, 04114 Kyiv, Ukraine,, Tel., Fax: (+38044) 432-85-88;
e-mail: ae@kovalenko.co.ua
ORCID: http://orcid.org/0000-0003-0326-6421


M. Yu. Bolgov, Коmisarenko Іnstitute of Endocrinology and Metabolism of Substances, Kyiv

Michail Bolgov, MD, PhD
Endocrine surgeon, Department of endocrine surgery,
Komisarenko Institute of Endocrinology and Metabolism,
Adress: Vyshgorodska Str., 69, 04114 Kyiv, Ukraine,, Tel., Fax: (+38044) 430-36-94;
e-mail: mikebolgov@gmail.com
ORCID: https://orcid.org/0000-0002-9011-9982


O. M. Gulko, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleh Gulko, MD, PhD
Surgeon oncologist, Department of combined pathology and retroperitoneal surgery,
Shalimov National Institute of Surgery and Transplantology,
Adress: 30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine, tel.: +38 (044)4542079
email: gulkoleg@gmail.com
ORCHID: https://orcid.org/0000-0001-8191-7141


V. A. Kondratiuk, Shalimov National Institute of Surgery and Transplantology, Kyiv

Vadym Kondratiuk, MD, PhD
senior researcher Department of Endovascular Surgery
Shalimov National Institute of Surgery and Transplantology,
Address: 30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine, tel.: +38 (044)4542079
email: vkondr@gmail.com
ORCHID: https://orcid.org/0000-0002-2506-5009


O. M. Symonov, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleh Symonov, MD,
Surgeon oncologist, Department of combined pathology and retroperitoneal surgery,
Shalimov National Institute of Surgery and Transplantology,
Address: 30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine, tel.: +38 (044)4542079
email: Dr.Simonov84@gmail.com
ORCHID: https://orcid.org/0000-0003-1558-9260

Published
2019-04-28
How to Cite
Skums, A. V., Kovalenko, A. E., Bolgov, M. Y., Gulko, O. M., Kondratiuk, V. A., & Symonov, O. M. (2019). Roentgenendovascular occlusion of the suprarenal gland vessels as a method of prophylaxis of complications in laparoscopic adrenalectomy for pheochromocytoma. Klinicheskaia Khirurgiia, 86(4), 16-20. https://doi.org/10.26779/2522-1396.2019.04.16
Section
General Problems of Surgery