PHEOCHROMOCYTOMA

TOWARDS AN AUDIT OF
NATIONAL SURGICAL PRACTICE
NM Foley1, DJ Bowden1, G Kane2, C Fleming2, M Casey3, R Prichard2,
EW McDermott2, D Quill1, A Lowery4, MJ Kerin1
1. Department of Surgery, University College Hospital Galway
2. Department of Surgery, St Vincents University Hospital
3. Department of Histopathology, University College Hospital Galway
4. Department of Surgery, University Hospital Limerick
Background 1 of 4

Pheochromocytoma and Paraganglioma

Rare

Hormone secreting

Diagnostic challenge

10% are malignant

Background 2 of 4

Increasing use of imaging

Increasing Ix of htn in endocrine setting

Increasing pick-up rate for incidentalomata

Background 3 of 4

Changes in surgical practice

Heterogeneity of practice

Open
Laparoscopic
Retroperitoneoscopic

Perioperative management
Background 4 of 4

National registries

National joint registry

National cancer registry

Objectives

To obtain an overview of national surgical practice in

pheochromocytoma and paraganglioma
Methods 1

Databases from two tertiary centers

GUH

SVUH

Cases from 2001 - 2015

Methods 2

Demographics

Localisation

Pathology

Peri-operative Mx

Surgical Mx

Outcomes
Results 1

N = 28

27 Pheochromocytoma 1 Paraganglioma
One malignant pheo

10 male 18 female

Mean age 54 (range 21 - 80)

Results 2

18 patients were symptomatic at diagnosis

Peri-operative Mx

All received preoperative blockade

Phenoxybenzamine n=23
Prazocin n=1
Doxazocin n=1
Combination n=3
Results 3 Technique

Surgical Mx

Open n = 10

Lap n= 8

Retro n = 10 Open Laparoscopic Retroperitoneoscopic

2 conversions in each group

Results 3 Technique

Surgical Mx

Open n = 10

Lap n= 8

Retro n = 10 Open Laparoscopic Lap converted Retroperitoneoscopic Retro - converted

2 conversions in each group

Results 4

Complications
Min invasive 4/18
Open 6/10

Clavien-Dindo grading of complications

I n=2
II n=5
III n=1
IV n=7
Results 5

Median post operative stay

Open 12.5 days

Minimally invasive 4.5 days

Conclusions

Minimally invasive techniques demonstrate benefits in

Reduced morbidity

Reduced inpatient convalescence

Variety of surgical practice

Variety of perioperative practice

Scope for development of national registry