Surgery and Anesthesia for Pheochromocytoma - A
Series of 40 Operations
NARONG LERTAKYAMANEE, M.D., F.R.C.S.(Glasg), MPH(UNC-CH)*,
JARIYA LERTAKYAMANEE, M.D., F.R.C.A.(UK), MPH(UNC-CH)**,
PRADIT SOMPRAKIT, M.D., F.R.C.A.(UK), M.Sc. **,
THANYADEJ NIMMANWUDIPONG, M.D., F.R.C.S.T.*,
PEERA BURANAKITJAROEN, M.D.***,
KALPANGHA BHAVAKULA, M.D., F.R.C.P.C.**,
KUJA SINDHA V ANAND A, M.D., Hon F.R.C.S.Ed. *
Affiliation : * Department of Surgery,
* * Department of Anesthesia,
*** Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
AbstractPheochromocytoma is a catecholamine-producing tumor which can be life-threatening.
A series of 40 operations in 39 pheochromocytoma patients at a tertiary hospital in Thailand from
1976 to 1997 was reported. The patients were 30 females and 9 males; aged 7-73 years. One man
had 2 operations 5 years apart. The most common symptoms and signs were palpitation, headache
and hypertension. Preoperative management consisted of control of blood pressure and restoration
of intravascular volume by using prazosin, an alpha adrenergic blocker. New imaging techniques
have improved the ability to localize the tumors; 20 were found in the right adrenal giands, 14 in
the left, 1 patient had bilateral tumors, 4 in Organs of Zuckerkandl and I patient had metastatic
liver nodules. The operative procedures were 39 laparotomies and 1 laparoscopic surgery. The
surgical and anaesthetic procedures were presented, and nitroprusside was used to control intra-
operative blood pressure. Removal of tumors was successful in all cases except for I mortality due
to injury of the liver and massive blood loss. Other complications were postoperative pulmonary
edema and renal vein thrombosis. One patient had MEN type 2 and five cases were malignant.
Pheochromocytoma can be cured by surgery, but cooperation among surgeons, anesthesiologists and
internists is very important.
Keywords : Pheochromocytoma, Adrenalectomy, Surgery, Anesthesia
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