Surgical treatment of abdominal paragangliomas

Introduction: Extraperitoneal, abdominal paragangliomas arise usually from symphatetic system. Their typical features are the tendency to overproduct catecholamines and potential malignancy. The lesions are located usually paravertebrally, but while growing in an expanding manner they may appear between inferior vena cava and aorta. This site in the authors' opinion excludes laparoscopic tumorectomy. Material and methods: For the recent 8 years in the center there were 28 patients operated due to abdominal paragangliomas. The group consisted of 21 (75%) women and 7 (25%) man, aged 14 to 84 years (mean 47,9). In the 13 (46,4%) cases there was paroxysmal hypertension observed, followed by 10 (35,7%) cases of diabetes type 2 and 2 (7,1%) cases takotsubo acute coronary syndrome. In the preoperative period patients were qualified for either open or laparoscopic tumorectomy based on visualization and location in imaging studies. Results: All the patients were successfully operated on. There were 11 (39,3%) patients qualified for laparoscopy, while the following 17 (60,7%) for open approach due to the difficult access to the lesion. The mean operative time was 130 min for laparoscopy, and 120 min for open cases (p = 0.2). There were no local and general complications after both types of procedures. Conclusions: The location of paragangliomas between interior vena cava and aorta, especially at the level of renal vessels and over up to the diaphragm, practically excludes the use of laparoscopic access in the treatment of that pathology.