Feasibility of Laparoscopic Adrenalectomy for Large Pheochromocytomas

BACKGROUND AND OBJECTIVES The majority of surgeons consider large and potentially malignant pheochromocytomas an absolute contraindication for laparoscopic adrenalectomy (LA). The aim of this study was to evaluate the risks and outcomes of LA in patients with this anomaly. METHODS Five patients (2 males, 3 females) with large (>6 cm) pheochromocytomas were selected. Preoperative investigation demonstrated no evidence of invasive carcinoma. All patients received alpha-blocker preparation for at least 20 days. Laparoscopic adrenalectomy via a lateral transperitoneal approach was performed in all cases. RESULTS Patient's median age was 48 years, and the median tumor size was 10.8 cm. No capsular disruption and no hypertensive crises occurred during the operation. The median operating time was 148 minutes and blood loss was <150 mL. Conversion to open adrenalectomy occurred in 2 patients owing to intraoperative evidence of carcinoma. No postoperative morbidity or mortality occurred. All patients are disease free after a median follow-up of 13 months. CONCLUSIONS In experienced hands, LA can be proposed for large and potentially malignant pheochromocytomas. Conversion to open adrenalectomy is mandatory if local invasion, capsular disruption, or technical difficulties are observed during the operation.