Although I am not a surgeon,
I am often asked by patients about surgical approaches. One of the common
questions is how laparoscopic pheo resection can completely remove the tumor.
The ports look small; how can a tumor 5-cm large pass through the ports? Even
if the tumor can squeeze through the ports, will that cause fragmentation of the
tumor or cause tumor spillage? I usually
ask the patients to direct the questions to the surgeons but I do wonder if
tumor spillage can actually happen.
Then I saw a case report published
this year. It described a 64-year-old woman with a large (12-cm) pheo. The pheo
was resected laparoscopically. The tumor was completely removed but the tumor
capsule ruptured. Tumor histology showed relatively high cell division rate but
otherwise there was no suggestion that the tumor was malignant. Several months
later, the pheo recurred at the primary site and the abdominal wall where the
laparoscopic ports were. The tumor progressed quickly and the patient unfortunately
died of it.
The references cited in the
case report listed an older study published in 2001. Three patients with single
pheos 5.5-6.5-cm large had small multiple recurrent pheos at the same site of
the original pheos 3-4 years after laparoscopic resection. In all three cases, tumor
spillage was suspected by the surgeons. No abdominal wall seeding was found in
the 3 cases.
In retrospect, the case
reported this year probably had malignant pheo while the 3 earlier cases probably
had benign pheo. At any rate, pheo spillage indeed appears possible during
laparoscopic resection but should be very uncommon.
Dr. Pheo
