Risk factors for hemodynamic instability during laparoscopic resection of pheochromocytoma

Abstract

Background Laparoscopic adrenalectomy for pheochromocytoma is associated with high risk of intraoperative hemodynamic instability. Our study aimed to identify predictive factors for hemodynamic instability during laparoscopic resection of pheochromocytoma. Methods Between January 2011 and December 2021, 136 patients underwent unilateral laparoscopic adrenalectomy for pheochromocytoma. The patients were divided into 2 groups depending on the presence or absence of hemodynamic instability during surgery. Intraoperative hemodynamic parameters were compared between the 2 groups. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to intraoperative hemodynamic instability via both univariate analysis and multivariate logistic regression analysis. Results There was greater blood pressure fluctuations and higher maximum blood pressure and heart rate in the hemodynamic instability group. More patients need intraoperative administration of vasoactive drugs in the hemodynamic instability group. In the univariate analysis, presence of coronary artery disease, tumour size, and previous hypertension history were significantly associated with intraoperative hemodynamic instability. The multivariate logistic regression analysis showed that tumour size and previous hypertension history were independent risk factors for intraoperative hemodynamic instability. Conclusion Tumour size and previous hypertension history were associated with hemodynamic instability during laparoscopic resection of pheochromocytoma.

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

“…In agreement with our results, recently, one study in 136 patients who underwent unilateral laparoscopic adrenalectomy for pheochromocytoma showed that previous hypertension history was an independent risk factor for intraoperative hemodynamic instability. In this study, patients with hemodynamic instability had greater BP fluctuations and higher maximum BP during surgery [28]. Although the characteristics of normotensive PPGL are poorly known, it seems that normotensive patients have smaller tumors and lower secretion of catecholamines.…”

Hypertension and Cardiac Damage in Pheochromocytoma and Paraganglioma Patients: A 598 Single-Center Cohort Study

“…In our study, we observed 399(66.72%) patients had HT history at admission. Carefully monitoring of blood pressure before operation and HT history had already been raised awareness because these might be risk factors of hemodynamic instability during the removal of pheochromocytoma [11]. Although previous studies investigated LVMI in PPGL, the majority of them compared PPGL and EH patients, indicating that LVH was a prominent cardiac performance in PPGL than EH [4,12].…”