Pheochromocytoma

Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients

“…Incidence of intraoperative hemodynamic instability episodes during laparoscopic adrenalectomy for pheochromocytoma ranged from 17 to 83 %, which correlates with the findings in our study [1,4,13,[19][20][21]. In early studies, life-threatening intraoperative catecholamine release had been quickly identified as the causes of blood pressure variability and various cardiac arrhythmias leading to perioperative morbidity and mortality [3,4,8,10]. Since then, intraoperative hemodynamic instability episodes were considered to be related to postoperative morbidity and mortality rates.…”

“…Historically, the association between IHD and perioperative morbidity dates back to 1956 [8]. Since that time, routine use of alpha blockade and volume expansion has been incorporated into the perioperative optimization of patients prior to surgery, thereby avoiding hemodynamic instability [1,4,7,9,10].…”

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

“…Unfortunately, due to the lack of understanding of pathophysiology of catecholamine secreting tumors and no antihypertensive medication adrenalectomy for pheochromocytoma was associated with extremely high mortality exceeding 50% (2). Only in 1956 priestly used alpha-blockers perioperatively which resulted in dramatic reduction in postoperative mortality (3). In 1996 Gagner et al published a series of laparoscopic cases showing that minimally invasive access is safe and feasible (4).…”

Both preoperative alpha and calcium channel blockade impact intraoperative hemodynamic stability similarly in the management of pheochromocytoma

“…10 Intraoperative hemodynamic instability (IHD) is defined by the occurrence of both hypertensive and hypotensive intraoperative episodes during the same procedure. 1 Since 1956, preoperative medical management with blood pressure normalization has been applied widely to improve perioperative hemodynamic instability and postoperative morbidity and mortality 7,10,11 The preoperative medical management typically consists of alpha-adrenergic blockade in most regions of the world; however these drugs are expensive (>1,200 USD for a typical course of preoperative preparation) and hard for patients to obtain at most pharmacies. 9 Calcium channel blockers (CC-Bs) also have been used with good results 9,[12][13][14] ; however, it is controversial if one regimen is superior.…”