Persistent disease and recurrence in pheochromocytomas. Experience from a series of 136 pheochromocytomas .
EAES Academy. PATEAS K. 07/05/22; 363202; P266
KONSTANTINOS PATEAS
Contributions
Contributions
Abstract
Background:
Patients with pheochromocytoma or paraganglioma may present with residual disease or recurrence after the initial excision of the tumor. Although the grade of the tumor and the genetic predisposition play the most important role in the persistence of the disease , it seems that other factors , relevant with the first operation , contribute to their recurrence.
Aim: Our aim is to underline the importance of the recurrence at the progress of the disease through the presentation of 7 cases.
Methods:
From a series of 911 adrenalectomies, 136 were in the final pathology report pheochromocytomas. We present 7 patients who were re-operated for pheochromocytoma. Five of them have been operated on in other hospitals. They were 4 men and 3 women , 27 to 78 years old. In the 4 patients , the first procedure was done laparoscopically, at the one with retroperitoneal approach and at the others transabdominally. Five patients had a short free-disease period with normal biochemical and imaging results , but they presented recurrence after a period of 2 years. The other 2 patients had residual disease after the first operation with persistence of biochemical and imaging findings and with concomitant difficult control of their hypertension. All the reoperations were done via laparotomy.
Results:
Preoperatively, the patients were prepared with phenoxybenzamine and no one of them presented hemodynamic instability during the operation. Three right and 4 left open adrenalectomies were performed. The tumors had solid adhesions with the adjacent tissues but all were excised radically without macroscopic residual disease left behind and in one patient a concomitant splenectomy and left nephrectomy was done due to an invasion from the tumor(image 1). . One patient with residual disease at the site of the adrenal gland , also had adrenal tissue at the mesocolon of the transverse colon (pheochromocytomatosis) (image 2). A change at the PASS score was noted at all re-operations, from 1 to 4 from the first surgery to 6 to 8 in the reoperation. All patients had a normal postoperative course , with a mean time of hospitalization about 5 days.
Conclusion:
The radical resection at the initial procedure is determinant for the progression of disease in patients with pheochromocytoma. Diligent post-operative follow-up is crucial for the primordial detection of the recurrence and its treatment.
Patients with pheochromocytoma or paraganglioma may present with residual disease or recurrence after the initial excision of the tumor. Although the grade of the tumor and the genetic predisposition play the most important role in the persistence of the disease , it seems that other factors , relevant with the first operation , contribute to their recurrence.
Aim: Our aim is to underline the importance of the recurrence at the progress of the disease through the presentation of 7 cases.
Methods:
From a series of 911 adrenalectomies, 136 were in the final pathology report pheochromocytomas. We present 7 patients who were re-operated for pheochromocytoma. Five of them have been operated on in other hospitals. They were 4 men and 3 women , 27 to 78 years old. In the 4 patients , the first procedure was done laparoscopically, at the one with retroperitoneal approach and at the others transabdominally. Five patients had a short free-disease period with normal biochemical and imaging results , but they presented recurrence after a period of 2 years. The other 2 patients had residual disease after the first operation with persistence of biochemical and imaging findings and with concomitant difficult control of their hypertension. All the reoperations were done via laparotomy.
Results:
Preoperatively, the patients were prepared with phenoxybenzamine and no one of them presented hemodynamic instability during the operation. Three right and 4 left open adrenalectomies were performed. The tumors had solid adhesions with the adjacent tissues but all were excised radically without macroscopic residual disease left behind and in one patient a concomitant splenectomy and left nephrectomy was done due to an invasion from the tumor(image 1). . One patient with residual disease at the site of the adrenal gland , also had adrenal tissue at the mesocolon of the transverse colon (pheochromocytomatosis) (image 2). A change at the PASS score was noted at all re-operations, from 1 to 4 from the first surgery to 6 to 8 in the reoperation. All patients had a normal postoperative course , with a mean time of hospitalization about 5 days.
Conclusion:
The radical resection at the initial procedure is determinant for the progression of disease in patients with pheochromocytoma. Diligent post-operative follow-up is crucial for the primordial detection of the recurrence and its treatment.
Background:
Patients with pheochromocytoma or paraganglioma may present with residual disease or recurrence after the initial excision of the tumor. Although the grade of the tumor and the genetic predisposition play the most important role in the persistence of the disease , it seems that other factors , relevant with the first operation , contribute to their recurrence.
Aim: Our aim is to underline the importance of the recurrence at the progress of the disease through the presentation of 7 cases.
Methods:
From a series of 911 adrenalectomies, 136 were in the final pathology report pheochromocytomas. We present 7 patients who were re-operated for pheochromocytoma. Five of them have been operated on in other hospitals. They were 4 men and 3 women , 27 to 78 years old. In the 4 patients , the first procedure was done laparoscopically, at the one with retroperitoneal approach and at the others transabdominally. Five patients had a short free-disease period with normal biochemical and imaging results , but they presented recurrence after a period of 2 years. The other 2 patients had residual disease after the first operation with persistence of biochemical and imaging findings and with concomitant difficult control of their hypertension. All the reoperations were done via laparotomy.
Results:
Preoperatively, the patients were prepared with phenoxybenzamine and no one of them presented hemodynamic instability during the operation. Three right and 4 left open adrenalectomies were performed. The tumors had solid adhesions with the adjacent tissues but all were excised radically without macroscopic residual disease left behind and in one patient a concomitant splenectomy and left nephrectomy was done due to an invasion from the tumor(image 1). . One patient with residual disease at the site of the adrenal gland , also had adrenal tissue at the mesocolon of the transverse colon (pheochromocytomatosis) (image 2). A change at the PASS score was noted at all re-operations, from 1 to 4 from the first surgery to 6 to 8 in the reoperation. All patients had a normal postoperative course , with a mean time of hospitalization about 5 days.
Conclusion:
The radical resection at the initial procedure is determinant for the progression of disease in patients with pheochromocytoma. Diligent post-operative follow-up is crucial for the primordial detection of the recurrence and its treatment.
Patients with pheochromocytoma or paraganglioma may present with residual disease or recurrence after the initial excision of the tumor. Although the grade of the tumor and the genetic predisposition play the most important role in the persistence of the disease , it seems that other factors , relevant with the first operation , contribute to their recurrence.
Aim: Our aim is to underline the importance of the recurrence at the progress of the disease through the presentation of 7 cases.
Methods:
From a series of 911 adrenalectomies, 136 were in the final pathology report pheochromocytomas. We present 7 patients who were re-operated for pheochromocytoma. Five of them have been operated on in other hospitals. They were 4 men and 3 women , 27 to 78 years old. In the 4 patients , the first procedure was done laparoscopically, at the one with retroperitoneal approach and at the others transabdominally. Five patients had a short free-disease period with normal biochemical and imaging results , but they presented recurrence after a period of 2 years. The other 2 patients had residual disease after the first operation with persistence of biochemical and imaging findings and with concomitant difficult control of their hypertension. All the reoperations were done via laparotomy.
Results:
Preoperatively, the patients were prepared with phenoxybenzamine and no one of them presented hemodynamic instability during the operation. Three right and 4 left open adrenalectomies were performed. The tumors had solid adhesions with the adjacent tissues but all were excised radically without macroscopic residual disease left behind and in one patient a concomitant splenectomy and left nephrectomy was done due to an invasion from the tumor(image 1). . One patient with residual disease at the site of the adrenal gland , also had adrenal tissue at the mesocolon of the transverse colon (pheochromocytomatosis) (image 2). A change at the PASS score was noted at all re-operations, from 1 to 4 from the first surgery to 6 to 8 in the reoperation. All patients had a normal postoperative course , with a mean time of hospitalization about 5 days.
Conclusion:
The radical resection at the initial procedure is determinant for the progression of disease in patients with pheochromocytoma. Diligent post-operative follow-up is crucial for the primordial detection of the recurrence and its treatment.
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