Editorial Comment from Dr Utsumi et al. to Internal validation and decision curve analysis of a preoperative nomogram predicting a postoperative complication in pheochromocytoma surgery: An international study

Abstract

Obesity is not uniquely associated with pheochromocytoma, but might make surgery more challenging. In an analysis of the American College of Surgeons National Surgical Quality Improvement Program data from 2005 to 2008, increasing body mass, especially for a BMI of >35, was associated with an overall increased risk of POCs after adrenalectomy for any cause. 21 A study of 29 pheochromocytoma patients by Inaishi et al., however, showed that obesity, defined as a BMI >25, was not associated with any increased risk of intra-or POCs. 22 The present patient population, with a mean BMI of 26 AE 6 (range of 14-53), may have been more obese than the cited study and contributed to our finding that BMI was an independent predictor of a complication after pheochromocytoma resection.PC is an uncommon tumor, and so the present analysis of 153 patients represents one of the larger series reported. Still, sample size alone can limit the number of variables used in any logistic regression model and might not fully evaluate the true significance of such variables in an unrelated population. 23 Despite its limitations and granularity, and the need for validation on better controlled populations, the proposed nomogram combining BMI, tumor size and CCI score would seem intuitive, based on easily identified clinical features, and might help stratify patients who are at particular risk for a post-adrenalectomy clinical event in PC surgery.