Posterior Retroperitoneoscopic Approach to Extra-Adrenal Paragangliomas: A Single Center Experience

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BACKGROUND: Resections performed using the commonly applied minimally invasive transperitoneal approach for extra-adrenal paragangliomas (ePGLs) require a broader dissection area compared with the posterior retroperitoneoscopic approach (PRA) due to the location of the masses, which can elongate the operative time and increase the risk of injury to the adjacent structures. The aim of this case series was to evaluate the feasibility and safety of the PRA method, which has very few examples reported in the literature, for the treatment of abdominal paragangliomas. METHODS: Eight patients who underwent ePGL resection with PRA in a tertiary center between April 2018 and August 2024 were included. Demographic data, localization relative to the renal vein, operative time, tumor size, perioperative and postoperative complications, and length of hospital stay were assessed. RESULTS: Of the patients, 4 were male, and 4 were female. The mean age was 49±10.3 years, and the mean body mass index was 27±2.7 kg/m². Tumors were located on the left side in 6 patients and on the right side in 2 patients. Relative to the renal vein, 6 tumors were located superiorly and 2 inferiorly. One patient who had previously undergone surgery through an open anterior approach underwent PRA due to recurrence. The mean operative time was 108.4±20.5 minutes, with perioperative hypotensive episodes observed in 2 patients. No complications were noted during the postoperative follow-up. The mean length of hospital stay was 3.6±1.4 days. The mean tumor size was 34.9±18.6 mm, and the mean follow-up period was 30.5±25.5 months. Disease-related mortality was observed in 1 patient. CONCLUSION: PRA is a safe and feasible minimally invasive method for the treatment of ePGLs.

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