The risk of recurrent disease after resection of a phaeochromocytoma or paraganglioma dictates follow-up intensity and duration. Our goal was to systematically review the incidence and factors associated with recurrences or new tumours after complete resection.Design and method:
Pubmed and Embase were searched from 1980 to 2011 for studies published in English on patients with: non-metastatic phaeochromocytomas and thoraco-abdomino-pelvic paragangliomas; complete tumour resection; postoperative follow-up exceeding 1 month; recurrence or new tumour documented by pathology, hypersecretion and/or imaging tests.Design and method:
Clinical and methodological data were independently collected by two abstractors and reviewed by a third one. Incidence rates of new events after curative surgery were calculated for each study with sufficient information and pooled using random effect meta-analysis.Results:
Thirty-eight studies were selected from 3518 references, 36 reporting retrospective cohorts from the USA, Europe and Asia. Patient follow-up was neither standardised nor exhaustive in included studies. A clear description of patient retrieval methods was available for 9 studies, follow-up protocol and patient flow for 4 studies. Only two studies used multivariable methods to assess potential predictors of postoperative events.Results:
The overall rate of recurrent disease was 0.98 events/100 person-years (95% confidence interval 0.71, 1.25) according to random effect meta-analysis of data from 34 studies. The time pattern of new event risk was not assessed and data was scarce after the first 10 years of follow-up. Syndromic diseases and paragangliomas were consistently associated with a higher risk of new event in individual studies and in meta-regression analysis. However, the power of risk factor analysis within and across studies was very limited.Conclusions:
The risk of recurrent disease after complete resection of phaeochromocytoma may be lower than usually thought, although late events occur. Risk stratification is required to tailor the follow-up protocol after complete resection of a phaeochromocytoma or paraganglioma. Large multicentric studies are needed to this end.