Roentgenendovascular occlusion of the suprarenal gland vessels as a method of prophylaxis of complications in laparoscopic adrenalectomy for pheochromocytoma
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.
2. Kercher K, Park A, Matthews B, Rolband G, Sing R, Heniford B. Laparoscopic adrenalectomy for pheochromocytoma. Surgical Endoscopy And Other Interventional Techniques. 2002;16(1):100-2. doi: 10.1007/s00464-001-8171-1.
3. Kasahara T, Nishiyama T, Takahashi K. Laparoscopic adrenalectomy for pheochromocytoma: evaluation of experience and strategy at a single institute. BJU International. 2009;103(2):218-22. doi: 10.1111/j.1464-410x.2008.07894.x
4. Bai S, Yao Z, Zhu X, Li Z, Jiang Y, Wang R, et al. Risk factors for postoperative cardiovascular morbidity after pheochromocytoma surgery: a large single center retrospective analysis. Endocrine Journal. 2019;66(2):165-73. doi: 10.1507/endocrj.EJ18-0402.
5. Lenders J, Duh Q, Eisenhofer G, Gimenez-Roqueplo A, Grebe S, Murad M, et al. Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. doi: https://doi.org/10.1210/jc.2014-1498.
6. Bolliger M, Kroehnert J, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg. 2018;50(6):256-61. doi: https://doi.org/10.1007/s10353-018-0551-z
7. Brunaud L, Nguyen-Thi P, Mirallie E, Raffaelli M, Vriens M, Theveniaud P, et al. Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients. Surg Endosc. 2015;30(3):1051-9. doi: 10.1007/s00464-015-4294-7.
8. Randle R, Balentine C, Pitt S, Schneider D, Sippel R. Selective Versus Non-selective ?-Blockade Prior to Laparoscopic Adrenalectomy for Pheochromocytoma. Ann Surg Oncol. 2016 (August);24(1):244-50. doi: 10.1245/s10434-016-5514-7.
9. Kiernan C, Du L, Chen X, Broome J, Shi C, Peters M, et al. Predictors of Hemodynamic Instability During Surgery for Pheochromocytoma. Ann Surg Oncol. 2014;21(12):3865-71. doi:10.1245/s10434-014-3847-7.
10. Bruynzeel H, Feelders R, Groenland T, van den Meiracker A, van Eijck C, Lange J, et al. Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma. J Clin Endocrinol Metabol. 2010 (December);95(2):678-85. doi: 10.1210/jc.2009-1051.
11. Challis B, Casey R, Simpson H, Gurnell M. Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?. Clin Endocrinol. 2017;86(2):163-7. doi: 10.1111/cen.13252.
12. Dickson P, Alex G, Grubbs E, Ayala-Ramirez M, Jimenez C, Evans D et al. Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery. 2011;150(3):452-8. doi:10.1016/j.surg.2011.07.004.
13. Berends F, Van Der Harst E, Giraudo G, Terkivatan T, Kazemier G, Bruining H, et al. Safe retroperitoneal endoscopic resection of pheochromocytomas. World J Surg. 2002;26(5):527-31. doi: 10.1007/s00268-001-0261-7
14. Bunuan H, Alltree M, Merendino K. Gel foam embolization of a functioning pheochromocytoma. Am J Surg. 1978;136(3):395-8. doi: 10.1016/0002-9610(78)90304-5.
15. Pua U. Transarterial embolization of spontaneous adrenal pheochromocytoma rupture using polyvinyl alcohol particles. Singapore Med J. 2008;49(5): e126-e130. PMID: 18465036.
16. Habib M, Tarazi I, Batta M. Arterial embolization for ruptured adrenal pheochromocytoma. Curr Oncol. 2010;17(6):65-70. doi: 10.3747/co.v17i6.597.
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