International multicentre review of perioperative management and outcome for catecholamine-producing tumours: Perioperative management and outcome for catecholamine-producing tumours

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Abstract

Surgery for catecholamine-producing tumours can be complicated by intraoperative and postoperative haemodynamic instability. Several perioperative management strategies have emerged but none has been evaluated in randomized trials. To assess this issue, contemporary perioperative management and outcome data from 21 centres were collected.

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Most cited references 24

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Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005.

Anne-Paule Gimenez-Roqueplo, Graeme Eisenhofer, Robert B. Grossman … (2007)

The First International Symposium on Pheochromocytoma, held in October 2005, included discussions about developments concerning these rare catecholamine-producing tumors. Recommendations were made during the symposium for biochemical diagnosis, localization, genetics, and treatment. Measurement of plasma or urinary fractionated metanephrines, the most accurate screening approach, was recommended as the first-line test for diagnosis; reference intervals should favor sensitivity over specificity. Localization studies should only follow reasonable clinical evidence of a tumor. Preoperative pharmacologic blockade of circulatory responses to catecholamines is mandatory. Because approximately a quarter of tumors develop secondary to germ-line mutations in any one of five genes, mutation testing should be considered; however, it is not currently cost effective to test every gene in every patient. Consideration of tumor location, presence of multiple tumors, presence of metastases, and type of catecholamine produced is useful in deciding which genes to test. Inadequate methods to distinguish malignant from benign tumors and a lack of effective treatments for malignancy are important problems requiring further resolution.

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Clinical experience over 48 years with pheochromocytoma.

R E Goldstein, J A O'Neill, G W Holcomb … (1999)

To analyze the presentation, localization, surgical management, pathology, and long-term outcome of a large series of patients with pheochromocytomas. There are several areas of controversy pertaining to pheochromocytomas. Although many studies report a higher rate of malignancy for extraadrenal pheochromocytomas than for adrenal pheochromocytomas, the number of patients with the former tumor are small and statistical analysis is lacking. There has also been recent debate as to whether microscopic features of the tumor may be predictive of future behavior. From 1950 to 1998, the authors observed 108 pheochromocytomas in 104 patients. The outcome of these patients has been followed prospectively. The medical records of these patients were reviewed for data on the presentation, localization, surgical management, pathology, and outcome. Patient survival was analyzed using Kaplan-Meier survival distributions. This study included 66 female patients and 38 male patients. The average age at surgery was 42.3 years. Sporadic cases accounted for 84% of the patients; the other 16% had multiple endocrine neoplasia type 2, von Recklinghausen's disease, von Hippel-Lindau disease, or Carney's syndrome. Of 64 adrenal tumors, 55 were initially considered benign, 6 had microscopic malignant features, and 3 had malignant disease. Mean patient follow-up was 12.6 years. To date, in five additional patients (none with microscopic disease) malignant disease developed (13% overall rate of malignancy). Recurrence occurred as late as 15 years after resection. Of 26 extraadrenal pheochromocytomas, 14 were initially considered benign, 8 had microscopic malignant features, and 4 had malignant disease. Thus, 46% of patients had either malignant disease or tumors with malignant features. Mean patient follow-up was 11.5 years. In one patient with benign disease and in one patient with malignant features, malignant disease developed (23% overall rate of malignancy). The difference in the rate of malignancy was not statistically significant between adrenal and extraadrenal pheochromocytomas. Patients with adrenal and extraadrenal pheochromocytomas also had similar rates of survival (p = NS). The data suggest that patients with extraadrenal pheochromocytomas have the same risk of malignancy and the same overall survival as patients with adrenal pheochromocytomas. Lifelong follow-up of these patients is mandatory.

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Posterior retroperitoneoscopic adrenalectomy--results of 560 procedures in 520 patients.

Klaus Peitgen, Andreas Ommer, Klaus Mann … (2006)

The posterior retroperitoneoscopic adrenalectomy is less popular than the laparoscopic transabdominal method. Due to the direct approach to the adrenal glands, however, the posterior retroperitoneal access is easy to use and may offer advantages not available with other endoscopic procedures for adrenalectomy. Between July 1994 and March 2006, we performed 560 adrenalectomies (right side: n = 258; left side: n = 302) by the posterior retroperitoneoscopic approach in 520 patients (200 male, 320 female; age, 10 to 83 years). Of the 520 patients, 21 suffered from Cushing's disease, 499 patients had adrenal tumors (157 Conn's adenomas, 120 pheochromocytomas [13 bilateral], 110 Cushing's adenomas [6 bilateral], and 112 other tumors). Tumor size ranged from 0.5 to 10 cm (mean, 2.9 +/- 1.7 cm). The procedures were performed with the patients in the prone position usually with 3 trocars. Mortality was zero. Conversions to open or laparoscopic lateral surgery were necessary in 9 patients (1.7%). Major complications occurred in 1.3% of patients, minor complications in 14.4%. Mean operating time was 67 +/- 40 min and declined significantly (P < .001) from the early procedures (106 +/- 46 min) to the later operations (40 +/- 15 min). The posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. In experienced hands, this method represents the ideal approach in adrenal surgery.

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Author and article information

Journal

Journal ID (publisher-id): BJS

Title: British Journal of Surgery

Abbreviated Title: Br J Surg

Publisher: Wiley

ISSN: 00071323

Publication date Created: January 2020

Publication date (Print): January 2020

Publication date (Electronic): January 05 2020

Volume: 107

Issue: 2

Pages: e170-e178

Affiliations

[1 ]Department of Anaesthesiology, Critical Care Medicine and Pain Therapy; Essen Germany

[2 ]Department of Minimally and General Surgery, Kliniken Essen-Mitte; Essen Germany

[3 ]Department of Anaesthesiology; Columbia University; New York

[4 ]Department of Anaesthesiology, Tufts Medical Center; Boston Massachusetts

[5 ]Department of Anaesthesiology, Academic Medical Centre Amsterdam; Amsterdam the Netherlands

[6 ]VU University Medical Centre Amsterdam; Amsterdam the Netherlands

[7 ]Department of Anaesthesiology and Perioperative Medicine; University of California; San Francisco California

[8 ]Department of Anaesthesiology and Intensive Care Medicine; Carl-Gustav Carus University Hospital Dresden; Dresden Germany

[9 ]Department of Urology; Carl-Gustav Carus University Hospital Dresden; Dresden Germany

[10 ]Department of Anaesthesiology; Heinrich Heine University Düsseldorf; Düsseldorf Germany

[11 ]Discipline of Surgery, School of Medicine; University of Ireland; Galway Ireland

[12 ]Department of Anaesthesiology; Sapporo Medical University School of Medicine; Sapporo Japan

[13 ]Endocrine Surgery Unit; Royal Melbourne Hospital; Melbourne Victoria Australia

[14 ]Department of Anaesthesia and Critical Care; University of Chicago Medical Center; Chicago Illinois

[15 ]Division of Surgical Oncology and Endocrine Surgery; Vanderbilt University; Nashville Tennessee

[16 ]Department of General and Endocrine Surgery; Harvard Medical School; Boston Massachusetts

[17 ]Division of Surgical Oncology - Endocrine Surgery; Medical College of Wisconsin; Milwaukee Wisconsin

[18 ]Department of Anaesthesiology; University of Groningen; Groningen the Netherlands

[19 ]Department of Anaesthesiology; Critical Care Medicine and Pain Therapy, Klinikum Bogenhausen; Munich Germany

[20 ]Department of Surgery; Oregon Health and Science University; Portland Oregon

[21 ]Department of Surgical Oncology; University of Texas MD Anderson Cancer Center; Houston

[22 ]Department of Anaesthesiology and Perioperative Medicine, Mayo Clinic; Rochester Minnesota USA

Article

DOI: 10.1002/bjs.11378

PMC ID: 8046358

PubMed ID: 31903598

SO-VID: 830e6c5b-a66c-42b7-9dc9-827869b3eb3a

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http://doi.wiley.com/10.1002/tdm_license_1.1

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International multicentre review of perioperative management and outcome for catecholamine-producing tumours : Perioperative management and outcome for catecholamine-producing tumours

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Most cited references 24

Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005.

Clinical experience over 48 years with pheochromocytoma.

Posterior retroperitoneoscopic adrenalectomy--results of 560 procedures in 520 patients.

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