gms | German Medical Science

Background: Surgery is the primary treatment of choice in retroperitoneal paragangliomas (rPG) as these tumors are potentially lethal by catecholamine excess. Up to now only very few and limited studies have demonstrated the option of minimally invasive surgery (MIS) in these patients. In the following study we present our data of patients with rPGs treated during the past 15 years by minimally invasive access.

Materials and methods: From 2000 until 2014 sixty-six patients (40M, 26F; mean age: 35 years [range: 8-82 years]) underwent surgery for rPG using MIS. During the same period an open approach was used in 3 patients with metastatic or recurrent malignant rPG. Underlying genetic diseases were found in 44 patients (von-Hippel-Lindau 25, SDHD 11, SDHB 7, SDHA 1), 22 patients suffered from sporadic rPG. Eleven patients had multiple rPG, and 8 patients had recurrent disease. Altogether 91 rPG were removed by MIS. The retroperitoneoscopic access was used in 45 operations, the laparoscopic approach in 18. Combined laparoscopic/retroperitoneoscopic surgery was performed in 4 patients and in one patient an anterior extraperitoneal operation was done. All data were prospectively documented and retrospectively evaluated.

Results: Mortality was zero. Conversion to open surgery was necessary in 2 cases (1 bleeding, 1 difficult dissection). Median operating time was 75 minutes (range 18-630 minutes). Mean blood loss was 109 ml (range 0-2500 ml), blood transfusions were given in one patient. Median hospital stay was 3 days. One patient died from multiple metastases. Two other patients developed distant metastasis. Altogether, 5% of the patients had malignant rPG.

Conclusion: Minimally invasive surgery for rPG is safe and should be recommended in the majority of cases. The laparoscopic approach is indicated in tumors caudally the renal vessels, the retroperitoneoscopic access above this level.