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May 5, 2004

Outcome of Laparoscopic Adrenalectomy for Pheochromocytomas vs Aldosteronomas

Author Affiliations

From the Departments of General Surgery (Drs Kim, Quiros, and Prinz and Mr Maxhimer) and Anesthesiology (Dr El-Ganzouri), Rush University Medical Center, Chicago, Ill.

Arch Surg. 2004;139(5):526-531. doi:10.1001/archsurg.139.5.526

Hypothesis  Laparoscopic adrenalectomy (LA) is most commonly performed for pheochromocytomas (PHEs) and aldosteronomas (ALDs). We hypothesize that LA for these differing tumor types is associated with different operative courses and outcomes.

Design  Retrospective study of a 10-year experience with LA.

Setting  University teaching hospital.

Patients  Laparoscopic adrenalectomy was performed on 149 patients. During data analysis, the initial 35 LAs performed for various adrenal lesions were excluded to account for the learning curve. Twenty-six of 30 PHEs and 34 of 45 ALDs were included.

Main Outcome Measures  Analysis of variance was used to compare operative time, tumor size, estimated blood loss, and postoperative length of hospital stay between the PHE and ALD groups and subsets of these groups. χ2 Analysis was used to compare tumor location, transfusion requirements, conversion to open procedures, and incidence of major complications.

Results  Right-sided lesions occurred in 19 of 26 PHEs, and left-sided lesions occurred in 28 of 34 ALDs (P <.001). Mean ± SD tumor size of PHEs (4.9 ± 1.8 cm) was larger than that of ALDs (2.7 ± 1.7 cm) (P <.001). Mean ± SD operative time for PHEs vs ALDs was 191 ± 49 vs 162 ± 48 minutes (P = .02). Mean ± SD estimated blood loss was greater for PHEs (276 ± 298 mL) than for ALDs (196 ± 324 mL) (P = .33). Subset analysis revealed that the mean ± SD size of right-sided PHEs (5.3 ± 1.8 cm) was significantly larger than that of right-sided ALDs (3.0 ± 1.5 cm) (P=.001). Mean ± SD operative time for right-sided PHEs (198 ± 44 minutes) was longer than that for right-sided ALDs (145 ± 37 minutes) (P=.005). Six PHE patients required blood transfusions vs 2 ALD patients (P = .05). Two LAs, 1 PHE and ALD, were converted to open procedures. Mean ± SD length of hospital stay was longer for PHE patients vs ALD patients (4 ± 4 vs 2 ± 3 days; P = .08). Six PHE patients had complications vs 3 ALD patients (P = .13).

Conclusions  For PHEs, LA was associated with the removal of more right-sided lesions, larger tumors, longer operative times, and more complications. Trends toward greater estimated blood losses and longer hospital stays were observed for PHEs vs ALDs. Despite the advanced skills of an experienced surgeon, LA for PHEs is associated with a more complex course than for ALDs. Surgeons should begin performing LA for ALD early in their experience to avoid the potential pitfalls associated with PHEs.