Nomogram for predicting severe morbidity after pheochromocytoma surgery

Abstract

Purpose Although resection is the primary treatment strategy for pheochromocytoma, surgery is associated with a high risk of morbidity. At present, there is no nomogram for prediction of severe morbidity after pheochromocytoma surgery, thus the aim of the present study was to develop and validate a nomogram for prediction of severe morbidity after pheochromocytoma surgery. Methods The development cohort consisted of 262 patients who underwent unilateral laparoscopic or open pheochromocytoma surgery at our center between 1 January 2007 and 31 December 2016. The patients’ clinicopathological characters were recorded. The least absolute shrinkage and selection operator (LASSO) binary logistic regression model was used for data dimension reduction and feature selection, then multivariable logistic regression analysis was used to develop the predictive model. An independent validation cohort consisted of 128 consecutive patients from 1 January 2017 and 31 December 2018. The performance of the predictive model was assessed in regards to discrimination, calibration, and clinical usefulness. Results Predictors of this model included sex, BMI, coronary heart disease, arrhythmia, tumor size, intraoperative hemodynamic instability, and surgical duration. For the validation cohort, the model showed good discrimination with an AUROC of 0.818 (95% CI, 0.745, 0.891) and good calibration (Unreliability test, P = 0.440). Decision curve analysis demonstrated that the model was also clinically useful. Conclusions A nomogram was developed to facilitate the individualized prediction of severe morbidity after pheochromocytoma surgery and may help to improve the perioperative strategy and treatment outcome.

Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study

“…Interestingly, in this study tumour size was not associated with the development of postoperative complications in multivariable analysis, which is in contrast with data from other studies 18 , 19 . Although larger tumour size may be related to higher technical difficulties, the reasons behind our findings could be due to the evolution in the management of phaeochromocytoma excision in recent decades 20 .…”

Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

“…Nevertheless, differences in the reported prevalence of hypertensive crisis across the studies may be related with several factors, including different definitions for hypertensive crisis, variability in the presurgical preparation (alpha and/or beta blockade) and the fact that anesthetic and surgical management of these patients has improved in the last decades [22]. Regarding postoperative hypertensive crisis, in accordance with our study, it is an uncommon complication, usually occurring in less than 5% of the PPGL resections [23]. In fact, in the postoperative period, hypotensive episodes are considered one of the most frequent complications [5,24,25].…”

Is transperitoneal laparoscopic adrenalectomy for pheochromocytoma really more challenging? A propensity score-matched analysis

“…Our study suggests that TLA for PHEO using the transperitoneal anterior and submesocolic approach is as safe and effective as TLA performed for other types of tumours. This further supports the concept that other preoperative parameters are probably useful to predict the difficulty of laparoscopic adrenalectomy, such as sex, previous surgery, BMI, site and size of the lesion, associated procedures, and comorbidities [ 12 , 35 , 37 , 51 – 53 ].…”