Surgical treatment of abdominal paragangliomas
Abstract
Introduction: Extraperitoneal, abdominal paragangliomas most commonly originate from the sympathetic nervous system. Typical features include catecholamine overproduction and the potential for malignancy. Lesions are usually located paravertebrally, but when growing in a more expansive manner they may also appear between the inferior vena cava and aorta. In the authors’ opinion this site excludes laparoscopic tumourectomy.
Material and methods: Twenty-eight patients were selected for surgical management of abdominal paragangliomas in the past eight years at our endocrine surgical centre. This group consisted of 21 (75%) women and seven (25%) men, aged 14 to 84 years (mean 47.9). In 13 (46.4%) cases paroxysmal hypertension was observed. Type 2 diabetes was noted in another 10 (35.7%) patients, and Takotsubo acute coronary syndrome in two (7.1%). Patients were preoperatively qualified for either open surgery or laparoscopic tumourectomy based on visualisation and location of the tumours in imaging studies.
Results: All patients were successfully operated. Eleven (39.3%) patients qualified for laparoscopy, while the remaining 17 (60.7%) were treated with an open surgical approach due to difficult access to the lesion. The mean operative time was 130 minutes for laparoscopy and 120 minutes for laparotomy (p = 0.2). There were no local or general complications after either type of procedure.
Conclusions: The use of laparoscopic access is practically excluded in the treatment of paragangliomas located between the inferior vena cava and aorta, especially at the level of the renal vessels and extending superiorly to the diaphragm.
Keywords: paragangliomaspheochromocytomasurgery of paragangliomas
References
- Fischer T, Gaitonde S, Jones M, et al. Anatomic Location Is the Primary Determinant of Survival for Paragangliomas. Am Surg. 2017; 83(10): 1132–1136.
- Krawczyk A, Hasse-Lazar K, Pawlaczek A, et al. Germinal mutations of RET, SDHB, SDHD, and VHL genes in patients with apparently sporadic pheochromocytomas and paragangliomas. Endokrynol Pol. 2010; 61(1): 43–48.
- Pacak K. Pheochromocytoma and paraganglioma. www.endotext.org (07.04.2018).
- Ji XK, Zheng XW, Wu XL, et al. Diagnosis and surgical treatment of retroperitoneal paraganglioma: A single-institution experience of 34 cases. Oncol Lett. 2017; 14(2): 2268–2280.
- Gill T, Adler K, Schrader A, et al. Extra-adrenal pheochromocytoma at the organ of Zuckerkandl: a case report and literature review. Radiol Case Rep. 2017; 12(2): 343–347.
- Alemanno G, Bergamini C, Somigli R, et al. Abdominal paragangliomas: a quantitative prognostic score as predictive factor of the feasibility of the laparoscopic approach. Updates Surg. 2017; 69(4): 509–515.
- Abe T, Sazawa A, Harabayashi T, et al. Laparoscopic resection of paraaortic/paracaval neurogenic tumors: surgical outcomes and technical tips. Surg Endosc. 2016; 30(10): 4640–4645.
- Sho S, Yeh MW, Li N, et al. Single-incision retroperitoneoscopic adrenalectomy: a North American experience. Surg Endosc. 2017; 31(7): 3014–3019.
- Ayala-Ramirez M, Feng L, Johnson MM, et al. Clinical risk factors for malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: primary tumor size and primary tumor location as prognostic indicators. J Clin Endocrinol Metab. 2011; 96(3): 717–725.
- Kotecka-Blicharz A, Hasse-Lazar K, Handkiewicz-Junak D, et al. 131-MIBG therapy of malignant pheochromocytoma and paraganglioma tumors — a single-centre study. Endokrynol Pol. 2018; 69(3): 246–251.
