Laparoscopic surgery and hemodynamic changes during adrenalectomy for pheochromcytoma in childhood: management of two cases and literature review

Pheochromocytoma (PCC) is a catecholamine-secreting tumor arising from chromaffin cells of the adrenal medulla and extra-adrenal sites. Approximately 10% of this rare tumor is found in pediatric age group. Perioperative management of pheochromocytoma is a challenge that requires a multidisciplinary approach for optimal care and successful outcome. Surgical resection remains the mainstay treatment of symptomatic and medically refractory PCC. The operative risk comes from hypertensive spikes and arrhythmias due to painful stimulations and mass manipulation. Laparoscopic adrenalectomy (LA) has been accepted as the “gold standard” treatment modality for small-sized (<6 cm) PCC. Its use for larger PCC (>6 cm) was also reported in the literature. The laparoscopic approach allows minimal handling of the tumor with early control of the adrenal vein, and this results in lesser intraoperative hemodynamic alterations in comparison to open surgery. We report two cases of PCC in children, which we have treated with laparoscopic adrenalectomy with good outcome. The advantages of low morbidity, fewer complications, less intraoperative blood loss, quicker recovery, cure for hypertension and lack of hormonal recurrence, make LA an effective option in PCC.