Solorzano Carmen C, Lew John I, Wilhelm Scott M, Sumner William, Huang Wendy, Wu William, Montano Raquel, Sleeman Danny, Prinz Richard A
Department of Surgery, Sylvester Cancer Center, University of Miami/Jackson Memorial Medical Center, 1475 NW 12th Ave, Room 3550, Miami, FL 33136, USA.
Ann Surg Oncol. 2007 Oct;14(10):3004-10. doi: 10.1245/s10434-007-9489-2. Epub 2007 Aug 10.
Laparoscopic adrenalectomy (LA) is the preferred surgical approach for pheochromocytomas. We have investigated the changes in diagnosis, management and outcome of pheochromocytomas treated since the widespread advent of LA.
Data were collected retrospectively from 96 patients with pheochromocytomas that had been surgically treated at three tertiary referral centers.
There were 53 females. Mean age was 47 years (10-81). Tumors were found incidentally in 40% of patients. Of the 96 patients, 12 (13%) had familial syndromes. CT or MRI localized the adrenal lesion in all patients. MIBG scans obtained from 32 patients were concordant with the CT/MRI in 19, were false negative in 9 and misleading in 1, and altered management in only 3 patients. Mean tumor size was 5.6 cm (1.8-17). There were 92 adrenal pheochromocytomas and 9 paragangliomas. Laparoscopy was successful in 67 of 74 (91%) patients, with 20 of 67 (30%) having tumors of 6 cm or greater in size. Conversions to open procedures were performed in patients with 4 left, 2 right pheochromocytomas and 1 paraganglioma. Of the patients, 22 had an open procedure due to suspicion of malignancy or large tumors. Malignancy was observed in 4 of 92 (4.3%) pheochromocytomas and 4 of 9 (44%) paragangliomas. Average follow-up was 22 months (1-122). There were seven recurrences. Postoperative biochemical tests available in 64 patients were normal in 90%.
The diagnosis of pheochromocytoma was made incidentally in 40% of patients. MIBG is not necessary for unilateral non-hereditary pheochromocytomas localized by CT/MRI. LA is possible with excellent results in most patients, including for treatment of lesions 6 cm or greater in size with no signs of invasion. Laparoscopy should be used cautiously for paragangliomas because of a high rate of malignancy.
腹腔镜肾上腺切除术（LA）是嗜铬细胞瘤首选的手术方式。我们研究了自LA广泛应用以来嗜铬细胞瘤在诊断、治疗及预后方面的变化。
回顾性收集了在三个三级转诊中心接受手术治疗的96例嗜铬细胞瘤患者的数据。
女性53例。平均年龄47岁（10 - 81岁）。40%的患者肿瘤为偶然发现。96例患者中，12例（13%）有家族综合征。CT或MRI对所有患者的肾上腺病变均有定位。32例患者进行了间碘苄胍（MIBG）扫描，其中19例与CT/MRI结果一致，9例为假阴性，1例有误导性，仅3例患者的治疗方案因此改变。肿瘤平均大小为5.6 cm（1.8 - 17 cm）。肾上腺嗜铬细胞瘤92例，副神经节瘤9例。74例患者中67例（91%）腹腔镜手术成功，其中67例中有20例（30%）肿瘤大小在6 cm及以上。4例左侧、2例右侧嗜铬细胞瘤及1例副神经节瘤患者中转开腹手术。22例患者因怀疑恶性或肿瘤较大而行开腹手术。92例嗜铬细胞瘤中有4例（4.3%）及9例副神经节瘤中有4例（44%）发现为恶性。平均随访22个月（1 - 122个月）。有7例复发。64例患者术后生化检查90%正常。
40%的患者嗜铬细胞瘤为偶然发现。对于CT/MRI定位的单侧非遗传性嗜铬细胞瘤，MIBG并非必需。大多数患者行LA效果良好，包括治疗6 cm及以上且无侵袭迹象的病变。由于副神经节瘤恶性率高，腹腔镜手术应谨慎用于副神经节瘤。
