Pheochromocytoma: 20 years of improving surgical care

Background: Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. Methods: A retrospective review was undertaken of pheochromocytoma adrenalectomy patients between 1997 and 2017. Clinical variables and postoperative complications were recorded. Patients were divided into quartiles for analysis: group 1 from 1997 to 2001, group 2 from 2002 to 2006, group 3 from 2007 to 2011, and group 4 from 2012 to 2017. Results: Eighty-two pheochromocytoma adrenalectomies were identified. The percentage of laparoscopic adrenalectomies increased over time: 60% in group 1–87.5% in group 4 (p = 0.03). The average tumor size decreased: 6.4 cm (2.8–14.3 cm) in group 1–4.6 cm (1.2–7.8 cm) in group 4 (p = 0.03). ICU utilization decreased from 80% to 40.6% (p = 0.03) and length of stay decreased from 7.2 days to 2.7 days (p = 0.005). Clavien-Dindo grade>3 complications did not differ between the quartiles (p = 0.08). Conclusion: Pheochromocytoma care has evolved from more open procedures with standard postoperative ICU stay to a laparoscopic resection with targeted ICU care and decreased length of stay. As experience with laparoscopic adrenalectomy increases, patient outcomes improve.