CHANGING TRENDS IN THE MANAGEMENT OF PHEOCHROMOCYTOMA

Background The recent experience of a specialist endocrine surgery uni t in the management of phaeochromocytoma is reviewed. Methods Over a 1 4-year period (June 1978 to June 1992) 43 patients (14 men, 29 women) with a mean age of 42 years were referred with phaeochromocytoma. Resu lts Biochemical confirmation was usually by measurement of 24-h urinar y vallinylmandelic acid. From 1980 venous sampling was replaced by com puted tomography as the primary localizing procedure. I-131-meta-iodob enzylguanidine scintigraphy was used in all patients between 1984 and 1987, but selectively after that. With regard to the operative approac h used, between 1978 and 1983 midline or flank incisions were used, an d from 1984 to 1992 subcostal or posterior approaches were used predom inantly. There was one operative (30-day) death. One patient died 24 m onths after operation from recurrent malignant phaeochromocytoma, and three patients died during follow-up from unrelated causes. The remain ing patients (mean follow-up 30 months) have no evidence of recurrent phaeochromocytoma, although four remain on antihypertensive medication . Conclusion Improved imaging of phaeochromocytoma obviates the need f or transperitoneal exploration, allowing selected phaeochromocytomas t o be successfully managed using an extraperitoneal approach.