Klinik Araştırma
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Feokromositoma Cerrahisi; 3. Basamak Merkez Deneyimi

Yıl 2021, Cilt 2, Sayı 3, 166 - 171, 17.11.2021

Öz

Giriş: Feokromasitoma 100.000’ de 0.8 görülen bir nöroendokrin tümördür. Salgılanan katekolaminlerin niteliğine ve niceliğine bağlı olarak çeşitli semptomlar gözlenmektedir. Lokalize hastalıkta tedavi cerrahidir. Preoperatif ve perioperatif dönemde hastanın uygun medikasyonu ve monitörizasyonu önem arz eder. Nadir görülen bu hastalığın cerrahi tedavisine ilişkin, kliniğimizdeki 5 yıllık tecrübemizi tartışmayı amaçladık.
Yöntemler: Ocak 2016 – Ocak 2021 tarihleri arasında Osmangazi Üniversitesi Genel Cerrahi Kliniğinde adrenalektomi uygulanan hastalar geriye dönük tarandı. Demografik ve klinikopatolojik veriler kaydedildi ve analiz edildi.
Bulgular: Çalışmaya dahil edilen hastaların 15’ i (%75) erkek, 5’ i (%25) kadın olup yaş ortalaması 49.5 (23-69) idi. En sık semptom terleme idi (n=17, %85). Opere edilen hastaların 12’ sinde (%60) lezyon sağ, 8’ inde (%40) sol adrenaldeydi. Ortalama tümör çapı 44.65mm (6-70mm) idi. Histopatolojik incelemede tüm olgularda tümör soliterdi. Hastaların 2’ sinde (%10) histopatolojik incelemede malignite saptandı. Hastaların 16’ sında (%80) laparoskopik teknik, 2’ sinde (%10) açık transperitoneal teknik uygulandı. Diğer 2 hastada ise (%10) operasyona laparoskopik başlandı fakat teknik zorluklar nedeni ile açık anterior tekniğe geçildi. Hastaların 6’ sında (%30) perioperatif taşiaritmi, 3’ ünde (%15) perioperatif hipertansif kriz izlendi.
Sonuç: Feokromasitoma her iki cinsiyet ve yaşta görülebilen nadir bir tümördür. Önemli bir sekonder hipertansiyon nedenidir. Çoğu hastada tümör insidental olarak saptanır. Feokromasitomanın rezeksiyonu yüksek riskli bir cerrrahi prosedürdür. Operasyon sırasında adrenal gland manipülasyonuyla katekolaminlerin sistemik dolaşıma salınımı sonrası akut hipertansif atak, taşiaritmi ve kardiyovasküler kollaps görülebilir. Bu nedenle tedavinin deneyimli cerrahi ve anestezi ekibine sahip yüksek volümlü merkezlerde uygulanması önerilmektedir.

Kaynakça

  • 1. Bryant J, Farmer J, Kessler LJ, Townsend RR, Nathanson KL. Pheochromocytoma: the expanding genetic differential diagnosis. J Natl Cancer Inst. 2003;95(16):1196-204.
  • 2. Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab. 2005;90(4):2110-6.
  • 3. Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983;58(12):802-4.
  • 4. Young WF Jr. Adrenal causes of hypertension: pheochromocytoma and primary aldosteronism. Rev Endocr Metab Disord. 2007;8(4):309-20.
  • 5. Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med. 2001;134(4):315-29.
  • 6. Guerrero MA, Schreinemakers JM, Vriens MR, et al. Clinical spectrum of pheochromocytoma. J Am Coll Surg. 2009;209(6):727-32.
  • 7. Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore). 1991;70(1):46-66.
  • 8. Neumann HPH, Young WF Jr, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med. 2019;381(6):552-65.
  • 9. Baguet JP, Hammer L, Mazzuco TL, et al. Circumstances of discovery of phaeochromocytoma: a retrospective study of 41 consecutive patients. Eur J Endocrinol. 2004;150(5):681-6.
  • 10. Kudva YC, Young WFJ, Thompson GB, Grant CS, van Heerden JA. Adrenal Incidentaloma: An Important Component of the Clinical Presentation Spectrum of Benign Sporadic Adrenal Pheochromocytoma. The Endocrinologist. 1999;9:77-80.
  • 11. Welbourn RB. Early surgical history of phaeochromocytoma. Br J Surg. 1987;74(7):594-6.
  • 12. Pullerits J, Ein S, Balfe JW. Anaesthesia for phaeochromocytoma. Can J Anaesth. 1988;35(5):526-34.
  • 13. Whalen RK, Althausen AF, Daniels GH. Extra-adrenal pheochromocytoma. The Journal of urology. 1992;147:1-10.
  • 14. Amar L, Bertherat J, Baudin E, et al. Genetic testing in pheochromocytoma or functional paraganglioma. J Clin Oncol. 2005;23(34):8812-8.
  • 15. Sever PS, Roberts JC, Snell ME. Phaeochromocytoma. Clin Endocrinol Metab. 1980;9(3):543-68.
  • 16. Serin SO, Güçlü M, Ersoy C, Koray A, Öznur B, İmamoğlu Ş. 10 yıllık feokromasitoma deneyimi ve literatüre bakış. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2009;35:11-6.
  • 17. Latronico AC, Chrousos GP. Extensive personal experience: adrenocortical tumors. J Clin Endocrinol Metab. 1997;82(5):1317-24.
  • 18. Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: which test is best? JAMA. 2002 Mar 20;287(11):1427-34.
  • 19. Plouin PF, Chatellier G, Rougeot MA, et al. Recent developments in pheochromocytoma diagnosis and imaging. Adv Nephrol Necker Hosp. 1988;17:275-86.
  • 20. Sawka AM, Jaeschke R, Singh RJ, Young WF Jr. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab. 2003;88(2):553-8.
  • 21. Welch TJ, Sheedy PF 2nd, van Heerden JA, Sheps SG, Hattery RR, Stephens DH. Pheochromocytoma: value of computed tomography. Radiology. 1983;148(2):501-3.
  • 22. Han S, Suh CH, Woo S, Kim YJ, Lee JJ. Performance of 68Ga-DOTA-Conjugated Somatostatin Receptor-Targeting Peptide PET in Detection of Pheochromocytoma and Paraganglioma: A Systematic Review and Metaanalysis. J Nucl Med. 2019;60(3):369-76.
  • 23. Janssen I, Chen CC, Millo CM, et al. PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging. 2016;43(10):1784-91.
  • 24. Gökhaner MŞ. İntraoperatif Malign Hipertansiyon ile Ortaya Çıkan Feokromasitoma Olgusunda Anestezi Yönetimi. Çağdaş Tıp Dergisi.2016;6:360-4.
  • 25. Buitenwerf E, Osinga TE, Timmers HJLM, et al. Efficacy of α-Blockers on Hemodynamic Control during Pheochromocytoma Resection: A Randomized Controlled Trial. J Clin Endocrinol Metab. 2020;105(7):2381–91.
  • 26. Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42.
  • 27. Nehs MA, Ruan DT. Minimally invasive adrenal surgery: an update. Curr Opin Endocrinol Diabetes Obes. 2011;18(3):193-7.
  • 28. Nomine-Criqui C, Brunaud L, Germain A, et al. Robotic lateral transabdominal adrenalectomy. J Surg Oncol. 2015;112(3):305-9.
  • 29. Aliyev S, Karabulut K, Agcaoglu O, et al. Robotic versus laparoscopic adrenalectomy for pheochromocytoma. Ann Surg Oncol. 2013;20(13):4190-4.
  • 30. Bihain F, Klein M, Nomine-Criqui C, Brunaud L. Robotic adrenalectomy in patients with pheochromocytoma: a systematic review. Gland Surg. 2020;9(3):844-848.
  • 31. Tuncel A, Balcı M, Köseoğlu E, et al. Transperitoneal laparoscopic adrenalectomy: five years' experience with 35 patients. Turk J Urol. 2013;39(4):214-9.
  • 32. Bravo EL. Pheochromocytoma: new concepts and future trends. Kidney Int. 1991;40(3):544-56.

PHEOCHROMACYTOMA SURGERY; A TERTIARY CENTER EXPERIENCE

Yıl 2021, Cilt 2, Sayı 3, 166 - 171, 17.11.2021

Öz

It is therefore recommended that the operation be performed in high-volume centers by experienced surgical and anesthesia teams.

Kaynakça

  • 1. Bryant J, Farmer J, Kessler LJ, Townsend RR, Nathanson KL. Pheochromocytoma: the expanding genetic differential diagnosis. J Natl Cancer Inst. 2003;95(16):1196-204.
  • 2. Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab. 2005;90(4):2110-6.
  • 3. Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983;58(12):802-4.
  • 4. Young WF Jr. Adrenal causes of hypertension: pheochromocytoma and primary aldosteronism. Rev Endocr Metab Disord. 2007;8(4):309-20.
  • 5. Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med. 2001;134(4):315-29.
  • 6. Guerrero MA, Schreinemakers JM, Vriens MR, et al. Clinical spectrum of pheochromocytoma. J Am Coll Surg. 2009;209(6):727-32.
  • 7. Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore). 1991;70(1):46-66.
  • 8. Neumann HPH, Young WF Jr, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med. 2019;381(6):552-65.
  • 9. Baguet JP, Hammer L, Mazzuco TL, et al. Circumstances of discovery of phaeochromocytoma: a retrospective study of 41 consecutive patients. Eur J Endocrinol. 2004;150(5):681-6.
  • 10. Kudva YC, Young WFJ, Thompson GB, Grant CS, van Heerden JA. Adrenal Incidentaloma: An Important Component of the Clinical Presentation Spectrum of Benign Sporadic Adrenal Pheochromocytoma. The Endocrinologist. 1999;9:77-80.
  • 11. Welbourn RB. Early surgical history of phaeochromocytoma. Br J Surg. 1987;74(7):594-6.
  • 12. Pullerits J, Ein S, Balfe JW. Anaesthesia for phaeochromocytoma. Can J Anaesth. 1988;35(5):526-34.
  • 13. Whalen RK, Althausen AF, Daniels GH. Extra-adrenal pheochromocytoma. The Journal of urology. 1992;147:1-10.
  • 14. Amar L, Bertherat J, Baudin E, et al. Genetic testing in pheochromocytoma or functional paraganglioma. J Clin Oncol. 2005;23(34):8812-8.
  • 15. Sever PS, Roberts JC, Snell ME. Phaeochromocytoma. Clin Endocrinol Metab. 1980;9(3):543-68.
  • 16. Serin SO, Güçlü M, Ersoy C, Koray A, Öznur B, İmamoğlu Ş. 10 yıllık feokromasitoma deneyimi ve literatüre bakış. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2009;35:11-6.
  • 17. Latronico AC, Chrousos GP. Extensive personal experience: adrenocortical tumors. J Clin Endocrinol Metab. 1997;82(5):1317-24.
  • 18. Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: which test is best? JAMA. 2002 Mar 20;287(11):1427-34.
  • 19. Plouin PF, Chatellier G, Rougeot MA, et al. Recent developments in pheochromocytoma diagnosis and imaging. Adv Nephrol Necker Hosp. 1988;17:275-86.
  • 20. Sawka AM, Jaeschke R, Singh RJ, Young WF Jr. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab. 2003;88(2):553-8.
  • 21. Welch TJ, Sheedy PF 2nd, van Heerden JA, Sheps SG, Hattery RR, Stephens DH. Pheochromocytoma: value of computed tomography. Radiology. 1983;148(2):501-3.
  • 22. Han S, Suh CH, Woo S, Kim YJ, Lee JJ. Performance of 68Ga-DOTA-Conjugated Somatostatin Receptor-Targeting Peptide PET in Detection of Pheochromocytoma and Paraganglioma: A Systematic Review and Metaanalysis. J Nucl Med. 2019;60(3):369-76.
  • 23. Janssen I, Chen CC, Millo CM, et al. PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging. 2016;43(10):1784-91.
  • 24. Gökhaner MŞ. İntraoperatif Malign Hipertansiyon ile Ortaya Çıkan Feokromasitoma Olgusunda Anestezi Yönetimi. Çağdaş Tıp Dergisi.2016;6:360-4.
  • 25. Buitenwerf E, Osinga TE, Timmers HJLM, et al. Efficacy of α-Blockers on Hemodynamic Control during Pheochromocytoma Resection: A Randomized Controlled Trial. J Clin Endocrinol Metab. 2020;105(7):2381–91.
  • 26. Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42.
  • 27. Nehs MA, Ruan DT. Minimally invasive adrenal surgery: an update. Curr Opin Endocrinol Diabetes Obes. 2011;18(3):193-7.
  • 28. Nomine-Criqui C, Brunaud L, Germain A, et al. Robotic lateral transabdominal adrenalectomy. J Surg Oncol. 2015;112(3):305-9.
  • 29. Aliyev S, Karabulut K, Agcaoglu O, et al. Robotic versus laparoscopic adrenalectomy for pheochromocytoma. Ann Surg Oncol. 2013;20(13):4190-4.
  • 30. Bihain F, Klein M, Nomine-Criqui C, Brunaud L. Robotic adrenalectomy in patients with pheochromocytoma: a systematic review. Gland Surg. 2020;9(3):844-848.
  • 31. Tuncel A, Balcı M, Köseoğlu E, et al. Transperitoneal laparoscopic adrenalectomy: five years' experience with 35 patients. Turk J Urol. 2013;39(4):214-9.
  • 32. Bravo EL. Pheochromocytoma: new concepts and future trends. Kidney Int. 1991;40(3):544-56.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Araştırma Makaleleri
Yazarlar

Dursun Burak ÖZDEMİR (Sorumlu Yazar)
Osmangazi Üniversitesi Tıp Fakültesi, Cerrahi Onkoloji B.D.
0000-0002-3672-5738
Türkiye


Hayrettin DİZEN
Osmangazi Üniversitesi Tıp Fakültesi, Cerrahi Onkoloji B.D.
0000-0002-4031-2557
Türkiye


Ahmet KARAYİĞİT
Osmangazi Üniversitesi Tıp Fakültesi, Cerrahi Onkoloji B.D.
0000-0003-0380-9190
Türkiye


Bülent ÜNAL
Osmangazi Üniversitesi Tıp Fakültesi, Cerrahi Onkoloji B.D.
0000-0003-2538-7961
Türkiye

Yayımlanma Tarihi 17 Kasım 2021
Yayınlandığı Sayı Yıl 2021, Cilt 2, Sayı 3

Kaynak Göster

Vancouver Özdemir D. B. , Dizen H. , Karayiğit A. , Ünal B. Feokromositoma Cerrahisi; 3. Basamak Merkez Deneyimi. Eskisehir Medical Journal. 2021; 2(3): 166-171.