Abstract
Severe hyperlactatemia (SH)/lactic acidosis (LA) after laparoscopic resection of pheochromocytoma is an infrequently reported complication. The study aims to investigate the incidence of this complication and to determine the clinical risk factors. Patients who underwent laparoscopic resection for pheochromocytoma between 2011 and 2014 at Peking Union Medical College Hospital were enrolled. LA was defined as pH < 7.35, bicarbonate <20 mmol/L, and serum lactate ≥5 mmol/L; SH as lactate ≥5 mmol/L; and moderate hyperlactatemia (MH) as lactate 2.5–5.0 mmol/L without evidence of acidosis (pH > 7.35 and/or bicarbonate >20 mmol/L). Data concerning patient demographics, clinical history, and laboratory results were collected and statistical analyses were performed. Out of 145 patients, 59 (40.7%) developed post-operative hyperlactatemia. The incidences of MH and SH/LA were 25.5% and 15.2%, respectively. Multivariate analysis demonstrated that body mass index (BMI) (odds ratio [OR], 1.204; 95% confidence interval [CI], 1.016–1.426), 24-hour urine epinephrine concentration (OR, 1.012; 95% CI, 1.002–1.022), and tumor size (OR, 1.571; 95% CI, 1.102–2.240) were independent predictors of post-operative SH/LA. The data show that post-operative SH/LA is not a rare complication after pheochromocytoma resection and may be closely associated with higher BMI, larger tumor size, and higher levels of urine epinephrine.
Highlights
Pheochromocytoma is a rare, catecholamine-producing neuroendocrine tumor originating from chromaffin cells of the adrenal medulla[1]
Owing to the rarity of pheochromocytoma, few studies have focused on the clinical factors resulting in post-operative severe hyperlactatemia (SH)/lactic acidosis (LA) in patients who have undergone laparoscopic adrenalectomy
The aim of this study was to evaluate the incidence of post-operative SH/LA and the clinical risk factors predisposing patients undergoing laparoscopic resection of pheochromocytoma to SH/LA
Summary
Pheochromocytoma is a rare, catecholamine-producing neuroendocrine tumor originating from chromaffin cells of the adrenal medulla[1]. Laparoscopic resection has become the first-line curative treatment for pheochromocytoma[2], it is likely to induce wide fluctuations of circulating catecholamines intra-operatively. LA, as a predictor of poor clinical outcome, may decrease myocardial contractility and cardiac output, can make the myocardium susceptible to cardiac arrhythmias, and can render the cardiovascular system insensitive to the effect of catecholamines[4]. Previous studies have reported a myriad of cases of SH/LA in patients with pheochromocytoma[5,6,7]. Owing to the rarity of pheochromocytoma, few studies have focused on the clinical factors resulting in post-operative SH/LA in patients who have undergone laparoscopic adrenalectomy. The aim of this study was to evaluate the incidence of post-operative SH/LA and the clinical risk factors predisposing patients undergoing laparoscopic resection of pheochromocytoma to SH/LA
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