Presentation and surgery outcomes in elderly with pheocromocytoma: a comparative analysis with young patients

Abstract

Purpose: To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma. Patients and Methods: A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients > 60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (< 60 years old). Results: The mean (+/- standard deviation) age in the older (n= 10) and younger (n= 36) groups was 69.6 +/- 5.3 years and 34.0 +/- 12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Post-operatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1 +/- 2.8 versus 1.4 +/- 1.0 days; p= 0.014), more clinical complications (60% versus 18.9%; p= 0.01), and longer hospital stay (10.2 +/- 8.4 versus 5.7 +/- 4.9 days; p= 0.028). Conclusions: Although all patients received the same preoperative preparation, the elderly group exhibited a slower and more complicated recovery after adrenalectomy. Meticulous perioperative care should be used in the elderly when treating phaeochromocytoma; nevertheless, adrenalectomy is a relatively safe procedure in this patient population.