PHEOCHROMOCYTOMA - CONTINUING EVOLUTION OF SURGICAL THERAPY

Background. The management of pheochromocytoma has evolved through ref inements in diagnosis, localization, and pharmacologic therapy for hem odynamic control both before and during operation. To provide a benchm ark for comparison and to assess the feasibility of surgical resection using a posterior or laparoscopic approach, we reviewed the overall m anagement and outcome Of 110 patients who underwent primary resection of pheochromocytoma or paraganglioma between 1980 and January 1992 at the Mayo Clinic. Methods. Patient records were reviewed for demographi c information, associated conditions, symptoms, laboratory evaluation, localizing techniques, preoperative adrenergic blockade, intraoperati ve hemodynamics, tumor location, pathologic conditions, and outcome. R esults. The most prominent symptoms included headaches, sweating, and palpitations. Forty-seven percent of patients had sustained hypertensi on, and classic paroxysmal attacks were present in 72%. The combinatio n of urinary metanephrines and vanillylmandelic acid had a sensitivity of 98% in detecting the disease. The positive and negative predictive values for localization of tumors by computed tomography scan were 95 % and 100%, respectively. With routine alpha- and beta-blockade, there were no complications associated with intraoperative hypertension. Pe rioperative mortality was less than 1% and morbidity was 16%. More tha n 90% of patients were restored to a condition of normotension; only 2 0% of these required medication. Conclusions. Surgical resection of th ese tumors, via a transabdominal approach, can be accomplished safely and hospitalization usually extends a week. Today the diagnosis, local ization, preoperative blockade, intraoperative hemodynamic control, an d postoperative management have reached a level sufficient to permit e ither a posterior or laparoscopic approach, but only if they can be ma stered technically.