63 Analysis of the Intra and Post-Operative Complications of Minimally Invasive vs Open Adrenalectomy in Patients with Phaeochromocytoma: A Systematic Literature Review

Aim

Phaeochromocytoma is a rare type of neuroendocrine tumour arising from the chromaffin cells of the adrenal medulla. The Endocrine Society suggest that minimally invasive (laparoscopic or robotic) adrenalectomy (MIA) should be performed unless the tumour is >6cm or invasive where open adrenalectomy (OA) is preferred. The aim of this review is to describe the intra and post-operative complications between the two surgical approaches.

Method

A thorough search was conducted on PubMed, EMBASE and Cochrane Library to find papers which analysed the intra and post-operative morbidity of adult patients with phaeochromocytoma. This review included only original studies written in English, after the year 2000. Our search strategy identified 10 papers which fulfilled our inclusion criteria. The PRISMA system was used for standardization.

Results

Haemodynamic instability was the major intra-operative complication. Patients having OA had significantly more frequent and greater fluctuations in their blood pressure during surgery. This was both in terms of hypertensive crises and hypotension too. Furthermore, significantly more patients required blood transfusion if they had an OA due to the higher degree of blood loss compared to the MIA (p<0.05).

The median number of days spent in the hospital post-operatively was significantly more for patients having OA (8.3 days vs 4.2 days). Finally, two papers analysing the number of patients having post-operative cardiovascular complications deduced that a higher proportion sustained such complications after OA than MIA (p = 0.002 and p = 0.041).

Conclusions

The results highlight the superiority of the MIA in terms of safety during and shortly after the procedure.