O tratamento laparoscópico de feocromocitoma
Palavras-chave:
laparoscopia, feocromocitoma, adrenalectomiaResumo
O tratamento do feocromocitoma consiste na excisão cirúrgica do tumor produtor de catecolaminas, na adrenal ou em localização extra-adrenal. A publicação dos primeiros casos de adrenalectomia laparoscópica, em 1992, causou uma revolução no tratamento das lesões adrenais. Desde então, a adrenalectomia laparoscópica vem sendo largamente realizada, constituindo, atualmente, o tratamento de escolha dos tumores adrenais benignos, funcionantes ou não. Com o objetivo de avaliar o papel da cirurgia laparoscópica no tratamento do feocromocitoma, fez-se uma revisão da literatura médica a partir do ano de 1992. A realização de expressivo número de cirurgias laparoscópicas no tratamento do feocromocitoma tornou possível verificar que as alterações metabólicas e hemodinâmicas são semelhantes às observadas com a cirurgia aberta, sem aumento de risco para a cirurgia laparoscópica, além de a cirurgia aberta estar associada a uma maior liberação de catecolaminas que a laparoscópica. A cirurgia laparoscópica, no feocromocitoma, também mostrou-se efetiva e segura quando foi realizada em casos de paragangliomas, em tumores bilaterais, em cirurgia retroperitoneoscópica e, inclusive, na adrenalectomia parcial laparoscópica de pequenos tumores, em pacientes com feocromocitoma familiar. Quando comparada com a cirurgia aberta, a adrenalectomia laparoscópica apresentou como vantagens um menor período de internação e convalescença, menor morbidade, mesma efetividade, segurança e melhores resultados estéticos. Vencida a curva de aprendizado, as duas técnicas já podem ser realizadas com igual dispêndio de tempo. A análise dos resultados demonstrou a eficácia e segurança da laparoscopia no tratamento do feocromocitoma.
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