Abstract
BackgroundSurgical manipulation of pheochromocytomas and paragangliomas (PPGLs) may induce large hemodynamic oscillations due to catecholamine release. Little is known regarding hemodynamic instability during percutaneous ablation of PPGLs. We examined intraprocedural hemodynamic variability and postoperative complications related to percutaneous ablation of extra-adrenal metastases of PPGL.MethodsFrom institutional PPGL registry we identified patients undergoing ablation of extra-adrenal PPGL metastases from January 1, 2000, through December 31, 2016. We reviewed medical records for clinical characteristics and hospital outcomes. Tumors were categorized as functional or nonfunctional based on preprocedural fractionated catecholamine and metanephrine profiles.ResultsTwenty-one patients (14 female [67%]) underwent 38 ablations. Twenty-four ablations were performed in patients with functional metastatic lesions, and 14 were in nonfunctional lesions. Intraprocedural use of potent vasodilators for hypertension was higher for patients with functional tumors (P = 0.02); use of vasopressors for hypotension was similar for functional and nonfunctional tumors (P = 0.74). Mean (±SD) intraprocedural blood pressure range (maximum–minimum blood pressure) during 38 procedures was greater for functional than nonfunctional tumors [systolic: 106 (±48) vs 64 (±30) mm Hg, P = 0.005; diastolic: 58 (±22) vs 35 (±14) mm Hg, P = 0.002; mean arterial: 84 (±43) vs 47 (±29) mm Hg, P = 0.007]. Complications included 5 unplanned intensive care unit admissions (3 for precautionary monitoring, 1 for recalcitrant hypotension, and 1 for hypertensive crisis), 1 case of postoperative bleeding, and 1 death.ConclusionsSubstantial hemodynamic instability may develop during ablation of functional and nonfunctional PPGL metastases. When anesthesia is provided for ablation of metastatic PPGLs in radiology suites, preparation for hemodynamic management should match standards used for surgical resection.
Highlights
Surgical manipulation of pheochromocytomas and paragangliomas (PPGLs) may induce large hemodynamic oscillations due to catecholamine release
We recently reported hemodynamic oscillations during open and laparoscopic operations of PPGL [15, 16]; we lack the knowledge regarding the extent of hemodynamic fluctuations during ablation of extra-adrenal PPGL metastases
Patient selection For this historical cohort study, we searched the Mayo Clinic, Rochester, Minnesota, PPGL Registry maintained by the Division of Endocrinology, Diabetes, Metabolism, and Nutrition to identify adult patients who were treated for metastatic lesions in radiology suites using minimally invasive thermal ablation, from January 1, 2000, through December 31, 2016
Summary
Surgical manipulation of pheochromocytomas and paragangliomas (PPGLs) may induce large hemodynamic oscillations due to catecholamine release. Little is known regarding hemodynamic instability during percutaneous ablation of PPGLs. We examined intraprocedural hemodynamic variability and postoperative complications related to percutaneous ablation of extra-adrenal metastases of PPGL. An estimated incidence of malignant PPGL in the United States in 2002 was 93 per 400 million persons [3]. Primary PPGLs are usually resected surgically, metastatic lesions can be treated using percutaneous imaging-guided thermal ablation [4, 5]. This is considered an optimal approach for treatment of focal unresectable metastatic lesions in the liver, bone, and lungs [6, 7]. Two major modalities of ablation are hyperthermic (radiofrequency ablation) and hypothermic (cryoablation)
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