Vol. 42 (4): 671-677, July – August, 2016
Victor Srougi 1, Jose L. Chambo 1, Fabio Y. Tanno 1, Iracy S. Soares 2, Madson Q. Almeida 3, Maria A. A. Pereira 3, Miguel Srougi 1, Maria C. Fragoso 3
1 Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 2 Divisão de Anestesiologia do Hospital das Clínicas da Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 3 Divisão de Endocrinologia do Hospital das Clínicas da Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil
Purpose: To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma.
Patients and Methods: A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients >60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (<60 years old).
Results: The mean (±standard deviation) age in the older (n=10) and younger (n=36) groups was 69.6±5.3 years and 34.0±12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Postoperatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1±2.8 versus 1.4±1.0 days; p=0.014), more clinical complications (60% versus 18.9%; p=0.01), and longer hospital stay (10.2±8.4 versus 5.7±4.9 days; p=0.028).
Conclusions: Although all patients received the same preoperative preparation, the elderly group exhibited a slower and more complicated recovery after adrenalectomy. Meticulous perioperative care should be used in the elderly when treating phaeochromocytoma; nevertheless, adrenalectomy is a relatively safe procedure in this patient population.
Keywords: Pheochromocytoma; Adrenalectomy; Surgical Procedures, Operative