Surgery is the treatment of choice for all patients except those who are thought to be medically unfit, those in whom a tumour has not been localised, or those in whom there are multiple metastases. Prior to surgery or any major investigative procedure, including CT scanning with intravenous contrast, patients should be given a combination of a- and b-blockade. The most commonly used a-blocker is phenoxybenzamine, which is usually used in conjunction with the b-blocker propranolol. In one regimen, 0.5mg/kg/d of phenoxybenzamine is administered over a period of four hours by venous drip, for three days, with 40mg propranolol given three times daily following the first phenoxybenzamine infusion.
