Totally Laparoscopic Resection of a Large Retroperitoneal Paraganglioma in an Older Patient: A Case Report on Precise Diagnosis and Perioperative Management.

INTRODUCTION

Paraganglioma is an extra-adrenal pheochromocytoma that requires surgical resection with strict perioperative management because of its catecholamine-producing nature. We report a case of successful laparoscopic resection of a large retroperitoneal paraganglioma in an older patient.

CASE PRESENTATION: An 80-year-old man was diagnosed with hypertension during a routine health checkup. Elevated plasma metanephrine and normetanephrine levels, along with radiological findings of a 6.5-cm tumor with 123I-metaiodobenzylguanidine accumulation anterior to the aorta, confirmed the diagnosis of retroperitoneal paraganglioma. Surgical resection was planned accordingly. Preoperative optimization with a selective α1 blocker was conducted over 2 months, and intravenous saline infusion was administered the day before surgery. Laparoscopic exploration revealed a tumor on the dorsal side of the small bowel mesentery, extending dorsally and caudally to the third portion of the duodenum. En bloc resection was performed using a six-port approach. Intraoperatively, systolic blood pressure transiently spiked to 170 mm Hg during tumor manipulation but was controlled with an intravenous bolus of phentolamine mesylate. Post-resection hypotension was effectively prevented by the continuous infusion of low-dose noradrenaline. Postoperatively, the blood pressure remained well controlled without medication, and no surgical complications occurred. Histopathological examination confirmed the diagnosis of a paraganglioma.

CONCLUSION

This case highlights the importance of precise diagnosis, meticulous perioperative planning and management, and minimally invasive surgery in the successful treatment of large retroperitoneal paragangliomas in older patients.