Pheochromocytomas are tumors composed of chromaffin cells that can produce, secrete and metabolise catecholamines. The surgical excision procedure of these tumors may present the risk of significant variations in blood pressure, as well as the chance of cardiovascular complications in the perioperative period. During surgery, patients may be at risk for cardiovascular events such as major variations in blood pressure, pulmonary edema, stroke, myocardial infraction and a long period of intubation. The surgical approach to pheochromocytomas must always be preceded by accurate imaging evaluation, endocrine screening and identification of associated genetic mutations. In addition, the surgical technique of choice consists in using minimally invasive surgical methods, with a transabdominal or retroperitoneal approach.
Part of the book: Pheochromocytoma, Paraganglioma and Neuroblastoma
The pathology of the adrenal gland and the clinical management of the adrenal clinical entities are particularly complex. The surgical approach to adrenal disorders, both in the classic way and especially in the minimally invasive way, is reserved for highly addressable centers and experienced surgeons. The surgical treatment is dedicated to both functional and nonfunctional adrenal tumors, closely following specific criteria. Regarding adrenal pathology, the surgical treatment is indicated for adrenal tumors that secret mineralocorticoid hormones (Conn syndrome), adrenal tumors secreting glucocorticoids (Cushing syndrome), pheochromocytomas, paragangliomas, neuroblastomas, adrenal carcinomas, and metastases. At the same time, non-secreting tumors should be removed as soon as imaging details are recorded an increasing dimensions of these tumors during a short time interval (up to one year). Although laparoscopic adrenal removal became a gold standard procedure in the late 90s, the classic open surgical adrenalectomy is reserved for bulky adrenal tumors and adrenal cancers, but it is overshadowed by possible multiple complications such as lung damage, wound infections, thrombosis, bleeding, etc. The minimally invasive approach, either laparoscopically or robotically, is dedicated to small tumors, with the advantage of rapid patient recovery, rapid socio-professional reintegration, and reduction of complications. Laparoscopic adrenalectomy is indicated in a wide range of pathologies, ranging from Conn adenoma, Cushing syndrome, and pheochromocytoma, to hormonal inactive tumors or other pathologies. The surgical sparing of the adrenal cortex is advised in cases of hereditary disorders affecting the adrenal gland (such as the MEN2 syndrome) in order to avoid primary adrenal insufficiency after the surgical excision. The postoperative evolution must be closely monitored by the anesthetic-surgical team, and the subsequent follow-up must not be neglected. We will discuss the primary surgical indications and contraindications of adrenal gland pathology in this chapter, as well as the perioperative management of specific tumors, surgical approach types, pluses and minuses of various adrenal surgery procedures, surgical technique and tactics, potential complications, and postoperative management.
Part of the book: Adrenal Glands - The Current Stage and New Perspectives of Diseases and Treatment