1 Department of Urology, Keio University School of Medicine , Tokyo, Japan .
J Endourol. 2014 Jun;28(6):686-92. doi: 10.1089/end.2013.0706. Epub 2014 Mar 24.
Paraganglioma (PGL) is a rare type of tumor that arises from the extra-adrenal paraganglia. A PGL tumor hypersecretes catecholamines and causes symptoms identical to those in patients with hyper-functioning adrenal pheochromocytoma (PCC). In this study, we compared the surgical outcome of laparoscopic surgery, including laparoendoscopic single-site (LESS) surgery, in patients with PCC and patients with retroperitoneal solitary PGL.
The records of 49 patients with PCC and 9 patients with unilateral retroperitoneal PGL at our institution from January 2001 to March 2013 were retrospectively reviewed. Multiple tumors, tumors suspected of being malignant preoperatively, and tumors operated on using a retroperitoneal approach were excluded from the study.
Each group was equivalent with respect to patient background, hemodynamic variables, and preoperative biochemical assessments, including plasma catecholamine levels and catecholamine levels in 24-hour urine samples. The mean operative time was significantly longer in the PGL group (149.4 ± 56.5 minutes v 189.8 ± 44.9 minutes, P=0.019). In univariate and multivariate analyses, tumor size ≥ 50 mm and PGL were statistically significant factors that predicted prolonged operative time. Intraoperative hypotension occurred in 15 patients in the PCC group and in 8 patients in the PGL group, and the difference was statistically significant (P=0.002). One postoperative complication in the PCC group and two postoperative complications (Clavien-Dindo grade II or higher) in the PGL group were observed, and the difference was statistically significant (P=0.012). Twenty-two patients in this series underwent LESS surgery (PCC: n=19; PGL: n=3), and there was no statistically significant difference in the perioperative outcomes between the two groups.
The present results demonstrate that the operation for solitary extraperitoneal PGL required a longer operative time and had more hypotensive episodes and higher postoperative morbidity than the PCC group. Though the perioperative outcome of LESS surgery for PGL is comparable to that of PCC, we should treat the patients with PGL accordingly.
副神经节瘤（PGL）是一种罕见的肿瘤，起源于肾上腺外的副神经节。PGL 肿瘤过度分泌儿茶酚胺，并引起与功能性肾上腺嗜铬细胞瘤（PCC）患者相同的症状。在这项研究中，我们比较了腹腔镜手术（包括腹腔镜单部位手术[LESS]）治疗 PCC 患者和腹膜后孤立性 PGL 患者的手术结果。
回顾性分析了 2001 年 1 月至 2013 年 3 月我院收治的 49 例 PCC 患者和 9 例单侧腹膜后 PGL 患者的病历资料。排除多发性肿瘤、术前怀疑恶性肿瘤和经腹膜后入路手术的患者。
两组患者的背景、血流动力学变量和术前生化评估（包括血浆儿茶酚胺水平和 24 小时尿液样本中的儿茶酚胺水平）相当。PGL 组的平均手术时间明显更长（149.4±56.5 分钟比 189.8±44.9 分钟，P=0.019）。在单因素和多因素分析中，肿瘤大小≥50mm 和 PGL 是预测手术时间延长的统计学显著因素。PCC 组有 15 例患者和 PGL 组有 8 例患者术中发生低血压，差异有统计学意义（P=0.002）。PCC 组有 1 例术后并发症，PGL 组有 2 例（Clavien-Dindo 分级 II 或以上）术后并发症，差异有统计学意义（P=0.012）。本系列中有 22 例患者接受了 LESS 手术（PCC：n=19；PGL：n=3），两组围手术期结果无统计学差异。
本研究结果表明，与 PCC 组相比，单侧腹膜后 PGL 的手术时间更长，术中低血压发作更多，术后发病率更高。虽然 PGL 的 LESS 手术围手术期结果与 PCC 相当，但我们应相应地治疗 PGL 患者。
