Outcomes of malignant pheochromocytoma based on operative ap
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Malignant pheochromocytoma is often managed with adrenalectomy. An open adrenalectomy is preferable in patients with larger malignant pheochromocytoma.

This study by the journal Surgery aimed to describe outcomes of adrenalectomy for malignant pheochromocytoma using a national database.

Patients who underwent adrenalectomy for malignant pheochromocytoma were identified in the National Cancer Database. Patients were categorized as minimally invasive adrenalectomy or open adrenalectomy. Short- and long-term outcomes were compared. A total of 276 patients underwent adrenalectomy for malignant pheochromocytoma: 50.7% open adrenalectomy and 49.3% minimally invasive adrenalectomy.

--Demographics were similar, except those who underwent open adrenalectomy had larger tumors compared to minimally invasive adrenalectomy.

--Tumor size ?6 cm was associated with a reduced likelihood of minimally invasive adrenalectomy on multivariable regression.

--Open adrenalectomy was associated with longer duration of stay relative to minimally invasive adrenalectomy.

--Rates of positive margins, unplanned readmissions, or 30-/90-day mortalities were similar based on operative approach.

--Five-year survival rates were similar. There was no association between overall survival and operative approach on multivariable Cox analysis when controlling for tumor size, laterality, and clinicodemographic variables.

In conclusion, patients with larger malignant pheochromocytomas were more likely to undergo an open adrenalectomy. With the exception of an increased duration of stay, there was no difference in short- or long-term postoperative outcomes. These data suggest that minimally invasive adrenalectomy appears safe among tumors <6 cm.

Source: https://doi.org/10.1016/j.surg.2021.04.001
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