Preoperative Alpha-Blocker Therapy in Patients with Missed Preoperative Diagnosis of Extra-Adrenal Retroperitoneal Paraganglioma Undergoing Resection: A Retrospective Study of 167 Cases at a Single Center

Abstract

<b><i>Introduction:</i></b> Preoperative α-adrenergic blockade is thought to decrease perioperative risks and mortality in surgeries for adrenal pheochromocytoma. However, there are limited data on the efficacy of α-blockers in surgeries for retroperitoneal paragangliomas. The aim of this study was to evaluate the effects of the preoperative α-adrenergic blockade on outcomes in patients undergoing surgery for extra-adrenal retroperitoneal paraganglioma. <b><i>Methods:</i></b> We searched the clinical database for patients diagnosed with extra-adrenal retroperitoneal paraganglioma by postoperative histopathology in the General Hospital of People’s Liberation Army in China from 2000 to 2017. We compared the preoperative status of patients, preoperative examination, preoperative preparation, intraoperative and postoperative cardiovascular events, intake and output, length of stay in the intensive care unit, length of hospital stays, and short-term outcomes between patients who received preoperative treatment with α-adrenergic blockade and those who did not. <b><i>Results:</i></b> Of the 167 patients enrolled in the study, 61 received preoperative α-adrenergic blockade therapy. Intraoperative heart rate elevation and highest heart rate were higher in patients undergoing tumor manipulation with preoperative α-adrenergic blockade than those who did not (<i>p</i> < 0.05). However, there were no significant differences between these 2 groups in terms of intraoperative blood pressure elevation and systolic blood pressure decrease following tumorectomy (<i>p</i> > 0.05). Moreover, there were no significant differences in postoperative complications and outcomes (<i>p</i> > 0.05). <b><i>Conclusion:</i></b> Under the current medical practice, resection of extra-adrenal retroperitoneal paraganglioma can be successfully carried out with or without preoperative α-adrenergic blockade.

Preoperative α-blockade versus no blockade for pheochromocytoma–paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis

“…Nine studies reported the maximum intraoperative systolic blood pressure, involving 879 procedures with preoperative α-blockade and 388 without 23 – 30 , 35 . No difference was shown in the pooled result between groups: MD=0.98 (−5.06, 7.02) mmHg ( P =0.75, I 2 =40%).…”

“…Seven studies reported the minimum intraoperative systolic blood pressure, involving 763 procedures with preoperative α-blockade and 215 without 24 – 27 , 29 , 30 , 35 . The pooled result showed a lower value associated with α-blockade, but the difference was not statistically significant: MD=−4.53 (−11.86, 2.79) mmHg ( P =0.23, I 2 =85%).…”

“…Intraoperative hypotensive HDI, defined as at least one episode of systolic blood pressure below 80 mmHg or mean arterial pressure below 60 mmHg, was reported in four studies of 523 procedures 28 , 30 , 34 , 35 . There was also no significant difference between groups: RR=1.07 (0.81, 1.41) ( P =0.65, I 2 =34%) (Fig.…”

“…Peak heart rate was reported in six studies involving 417 procedures 22 , 23 , 26 , 27 , 30 , 35 . Synthesized results showed no significant variation in overall effect: MD=3.58 (−1.42, 8.57) ( P =0.16, I 2 =27%), as well as in subgroup analysis of two studies focusing on normotensive patients 26 , 30 : MD=−0.74 (−7.20, 5.73) ( P =0.82, I 2 =0%) (Fig.…”

“…Five studies investigated postoperative ICU admission, involving 854 procedures 22 , 32 , 33 , 35 , 36 . The meta-analytic result showed a similar admission rate between groups: RR=1.29 (0.54, 3.09) ( P =0.56, I 2 =66%) (Fig.…”