Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach.

Salvatore Buscemi,Giuseppe Di Buono,Roberto Citarrella,Francesco Minni,Saverio Selva,Antonino Agrusa,Laura Alberici,Claudio Ricci,Rocco D’Andrea,Lorenzo Querci,Giorgio Romano

doi:10.3390/jcm10163759

Salvatore Buscemi, Giuseppe Di Buono + Show 9 more

Open Access

https://doi.org/10.3390/jcm10163759

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Abstract

Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, without alfa-blockers. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Univariate and multivariate analysis was conducted. A p-value < 0.05 was considered statistically significant. Results: Major postoperative complications were similar (p = 0.49). Advanced hemostatic agents were 44.9% in Group 1 and 100% in Group 2 (p < 0.001). In Group 2, no patients were admitted to the ICU, while only 73.5% of Group 1 (p < 0.001) were admitted. The median length of stay was larger in Group 1 than in Group 2 (p = 0.026). At the induction, SBP was 130 mmHg in Group 1, and 115 mmHg (p < 0.001). The pre-surgery treatment was the only almost statistically significant variable at the multivariate analysis of DBP at the end of surgery. Conclusion: The preoperative use of alfa-blockers should be considered not a dogma in PCC.

Highlights

Pheochromocytoma (PCC) is a neuroendocrine tumor originating from the chromaffin cell in the adrenal medulla that secretes the catecholamine
Laparoscopic resection was once considered not indicated in PCC, several studies in the last twenty years have demonstrated that laparoscopic adrenalectomy is associated with less pain, less morbidity, and quick recovery
Adrenalectomy for pheochromocytoma is reported with mortality close to zero in recent studies

Summary

Introduction

Pheochromocytoma (PCC) is a neuroendocrine tumor originating from the chromaffin cell in the adrenal medulla that secretes the catecholamine. It has a low incidence of 0.8 per. Laparoscopic resection was once considered not indicated in PCC, several studies in the last twenty years have demonstrated. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Results: Major postoperative complications were similar (p = 0.49). Advanced hemostatic agents were 44.9% in Group 1 and 100% in Group 2 (p < 0.001)

Methods

Discussion

Conclusion