Risk factors for hemodynamic instability during laparoscopic pheochromocytoma resection: a retrospective cohort study

Pisarska-Adamczyk, Magdalena; Zawadzka, Karolina; Więckowski, Krzysztof; Przęczek, Krzysztof; Major, Piotr; Wysocki, Michał; Małczak, Piotr; Pędziwiatr, Michał

doi:10.21037/gs-20-783

Cited by 13 publications

(17 citation statements)

References 29 publications

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“…There are several plausible explanations for this wide range, including referral biases, differences in the de nition of complications and in the type of complications reported, and importantly, the decade of the performed research as it is known that a signi cant reduction in pheochromocytoma surgical treatment morbidity and mortality has taken place over recent decades [20]. In agreement with our study, series evaluating the severity of complications found similar gures of grade III and IV complications in the Clavien-Dindo score [10][9] [11], although in some series severe complications occurred in up to 31% of the cases [8].…”

Section: Surgical Outcomessupporting

confidence: 84%

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Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

et al. 2021

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Purpose: To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery.Methods: A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classi ed according to Clavien-Dindo scale.Results: One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P=0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2±11.16 vs 6.2±6.82, P<0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n=16), followed by hypoglycaemia in 6 patients and acute renal failure in 4 patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. Conclusion:Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications. Introduction:Pheochromocytomas are rare neuroendocrine tumours that produce catecholamines [1]. They are a lifethreatening condition because catecholamine secretion is unpredictable, resulting in hypertension, arrhythmia, and/or other cardiovascular complications [2]. Surgery represents the primary treatment for pheochromocytomas [1]. Due to improvements in perioperative treatment, anaesthesia and surgical techniques, the mortality has dropped markedly in the last thirty years, but the risk of cardiovascular complications remains still high [3]. Intraoperative complications, including hypertensive crisis, hemodynamic instability and tachyarrhythmias, among others, have been reported in 30-50% of the pheochromocytoma surgeries [4][5][6]. The main postoperative major complications are prolonged hypotension and rebound hypoglycaemia [1]. However, postsurgical complications are usually less reported in pheochromocytoma studies, and are usually described in around 20-30% of the patients in recent series [4][7][8][9].Few studies have evaluated the grade of these complications using validate scales as the Clavien-Dindo score [4][10][9][8]. Moreover, studies evaluating risk factors for p...

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Section: Surgical Outcomessupporting

confidence: 84%

“…risk factors for postsurgical complications included diabetes [4], tumour size [11], preoperative total urinary metanephrine excretion [7], preoperative systolic blood pressure [7] and open adrenalectomy [12], among others.…”

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confidence: 99%

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

et al. 2021

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“…Bruynzeel and Brunaud indicated that intraoperative SBP above 160 mmHg was a risk factor for HI [ 2 , 8 ] and Aksakal et al revealed that HI was associated with the requirement of cardioactive or vasoactive drugs administration [ 10 ]. Integrating those findings, Pisarska-Adamczyk et al defined HI as an occurrence of both intraoperative episodes of SBP above 160 mmHg and requirement of vasoactive drug administration [ 7 ]. In our study, based on this definition, the hemodynamic parameters including the highest intraoperative BP, incidence of extreme hypertensive episodes, the highest HR and the range of BP fluctuation were significantly higher in the HI group, indicating it could objectively reflect the intraoperative hemodynamic status.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were divided into 2 groups depending on presence or absence of intraoperative HI. As previously described [ 7 ], HI was defined as an occurrence of intraoperative episodes of systolic blood pressure (SBP) above 160 mmHg and vasoactive drug administration.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for hemodynamic instability during laparoscopic resection of pheochromocytoma

Huang

Yan

et al. 2022

BMC Urol

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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.

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“…A low body mass index, large tumor size, coronary heart disease, no preoperative crystal/colloid administration, and intraoperative hemodynamic instability were independent risk factors for cardiovascular morbidity in this cohort [ 64 ]. Another observational study found that the size of the adrenal tumor and diabetes were significant factors for hemodynamic instability [ 65 ]. A very close cardiovascular vigilance in the intensive care unit is encouraged in all postsurgical patients during the immediate postoperative period.…”

Section: Postoperative Carementioning

confidence: 99%

Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas

Fagundes

Almeida

2022

Journal of the Endocrine Society

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Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia, respectively. PPGLs have the highest degree of heritability among endocrine tumors. Currently, ~40% of PPGL individuals have a genetic germline and there exist at least 12 different genetic syndromes related to these tumors. Metastatic PPGLs are defined by the presence of distant metastases at sites where chromaffin cells are physiologically absent. Approximately 10% of pheochromocytomas and ~40% of sympathetic paragangliomas are linked to metastases explaining why complete surgical resection is the first-choice treatment for all PPGL patients. The surgical approach is a high-risk procedure requiring perioperative management by a specialized multidisciplinary team in centers with broad expertise. In this review, we summarize and discuss the most relevant aspects of perioperative management in patients with pheochromocytomas and sympathetic paragangliomas.

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Risk factors for hemodynamic instability during laparoscopic pheochromocytoma resection: a retrospective cohort study

Cited by 13 publications

References 29 publications

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

Risk factors for hemodynamic instability during laparoscopic resection of pheochromocytoma

Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas

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