QUESTIONABILITY OF THE BENEFITS OF ROUTINE LAPAROTOMY AS THE SURGICALAPPROACH FOR PHEOCHROMOCYTOMAS AND ABDOMINAL PARAGANGLIOMAS

Background. Improvement of preoperative imaging of pheochromocytomas a nd abdominal paragangliomas may render routine laparotomy questionable as the surgical approach of choice for these lesions. Methods. We stu died the records of 100 patients with chromaffin tumors who underwent abdominal exploration. The disease was familiar in 28 patients and was malignant in 19. Seventy-five patients had intraadrenal disease (bila teral in 13). Computed tomography (CT), metaiodobenzylguaninine (MIBG) scintigraphy magnetic resonance imaging (MRI) were performed since 19 79, 1984, and 1987 in 97, 73, and 43 patients, respectively. False-Pos itive and false-negative results were defined as any discrepancy betwe en imaging results and surgical findings.Results. Overall accuracy of preoperative localization was 85% with CT scan, 77% with MIBG scintigr aphy, and 86% with MRL. In unilateral pheochromocytoma, accuracy was 9 4% with CT scan, 80% with MIBG scintigraphy and 96% with MRI. When all three studies were performed (n = 38), overall accuracy was 97% and o nly one extraadrenal tumor in a patient with familial pheochromocytoma was overlooked. Conclusions. The outstanding accuracy of available im aging techniques questions the strategy of routine laparotomy for spor adic and seemingly benign pheochromocytomas, favoring more elective ap proaches such as the posterior approach or laparoscopy.