Predictors of Hemodynamic Instability During Surgery for Pheochromocytoma

Kiernan, Colleen M.; Fan, Kang-Hsien; Broome, James T.; Shi, Chun-zhi; Peters, M.F.; Solórzano, Carmen C.

doi:10.1016/j.jss.2013.11.466

Cited by 17 publications

(35 citation statements)

References 15 publications

(28 reference statements)

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“…Moreover, case control studies confirmed that in terms of hemodynamic instability laparoscopic approach is equal to open procedure (50,51). Moreover, a study by Kiernan et al demonstrated that after open surgery the risk of increased number of episodes of systolic blood pressure >200 mmHg was 27 times higher comparing to laparoscopy (52). Minimally invasive surgery requires gentle, meticulous dissection.…”

Section: Intraoperative Considerationsmentioning

confidence: 93%

“…It has been shown that tumor size and preoperative levels of catecholamines (which correlate with tumor size) were associated with postoperative hemodynamic instability (53). According to Kiernan et al the need for vasopressors was significantly higher after open procedures in univariate analysis (52). It was not confirmed in a multivariate model when the size of the tumor was additionally taken into consideration.…”

Section: Postoperative Managementmentioning

confidence: 99%

“…The explanation of this phenomenon is on one hand high concentration of antihypertensive drugs, relatively low volume of circulating blood due to chronic vasospasm caused by catecholamines and their sudden decrease after surgery (13,48,52,53). Moreover, an association between down-regulation of alphaand beta-adrenergic receptors caused by catecholamines and postoperative hypotension was observed (54,55).…”

Section: Postoperative Managementmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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Section: Intraoperative Considerationsmentioning

confidence: 93%

Section: Postoperative Managementmentioning

confidence: 99%

Section: Postoperative Managementmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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“…Determinants of haemodynamic stability in this clinical situation remain unclear. Previous studies revealed some risk factors that may be associated with this issue including tumour size, preoperative blood pressure, surgical approach and catecholamine levels . However, some results from previous studies are conflicting, which still requires further exploration.…”

Section: Introductionmentioning

confidence: 99%

Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients

Jiang

Ding

et al. 2018

Clinical Endocrinology

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HI is common among Chinese patients undergoing surgery for pheochromocytoma. Our study identified three predictive factors for intraoperative HI: a large tumour diameter, diabetes/prediabetes and a great preoperative systolic blood pressure fluctuation. Furthermore, patients are more likely to suffer from HI when they have more predictive risk factors. Identification of these risk factors can help to improve perioperative management.

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“…Continuous invasive monitoring and pharmacologic intervention by an experienced anesthetic team perioperatively are necessary to avoid substantial cardiovascular instability. 19 When the main adrenal vein is ligated, antihypertensive drugs and β-blockers administration are stopped and hemodynamics are reassessed.…”

Section: Discussionmentioning

confidence: 99%

Surgery for pheochromocytoma: A 20-year experience of a single institution

Aggeli

Nixon

Parianos

et al. 2018

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oBJECTIvE: Resection of pheochromocytomas is a challenging procedure due to hemodynamic lability. our aim was to evaluate surgical outcomes in 67 patients with pheochromocytoma and to validate the role of laparoscopic surgery in the treatment of these tumors. DEsIgn: This study is a retrospective review. A total of 68 procedures for pheochromocytoma were performed between June 1997 and february 2017. All patients were investigated and operated on using an established departmental protocol. Relevant data were retrieved from the hospital records of 533 patients who underwent 541 adrenalectomies for benign and malignant adrenal tumors in the same period. REsuLTs: sixty-nine tumors were removed from 67 patients. one patient with/mEn2A underwent bilateral resection of pheochromocytomas in two stages. Tumor size in laparoscopic procedures ranged from 1.2 cm to 11.0 cm (mean 5.87 cm). Thirty-seven patients had benign disease, 31 potentially malignant (based on PAss) and 1 malignant with metastasis. Eight were in the context of a familial syndrome. forty-nine patients underwent laparoscopic adrenalectomy, 8 patients had open approach from the start for recurrent pheochromocytoma or large benign tumor, 1 patient had open approach due to inoperable malignant pheochromocytoma and 10 patients had conversions from laparoscopic to open procedure. nine patients received sodium nitroprusside intraoperatively to treat hypertension. one patient developed pulmonary embolism and succumbed 1 month later. There were no recurrences of the benign or potentially malignant tumors during the follow-up period. ConCLusIons: Laparoscopic resection of pheochromocytomas, despite its increased level of difficulty compared to that of other adrenal tumors, is a safe and effective procedure.

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Predictors of Hemodynamic Instability During Surgery for Pheochromocytoma

Cited by 17 publications

References 15 publications

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients

Surgery for pheochromocytoma: A 20-year experience of a single institution

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