The Duration of Preoperative Administration of Single α-Receptor Blocker Phenoxybenzamine before Adrenalectomy for Pheochromocytoma: 18 Years of Clinical Experience from Nationwide High-Volume Center.

Jie Tian,Zhou Liqun,Zhengqing Bao,Yonghao Zhan,Tianyu Wang,Zheng Zhang,Yiming Yuan,Dong Fang

doi:10.1155/2019/2613137

Abstract

Purpose There is no consensus for the optimum duration of preoperative administration of phenoxybenzamine (PXB) before adrenalectomy for pheochromocytoma. The aim of this study is to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of PXB administration. Methods In total, 102 patients managed preoperatively with single α-receptor blocker phenoxybenzamine were enrolled from 469 consecutive patients diagnosed histologically with pheochromocytoma. The patients received surgical treatment in the Department of Urology, Peking University First Hospital, between January 2001 and July 2018. All patients were divided into three groups: Group A (<14 d), Group B (14–30 d), and Group C (>30 d). Patient and tumor characteristics, intraoperative hemodynamics, and postoperative outcomes were recorded and compared among the three groups. Results These patients included 47 men and 55 women, with an average age of 43 years at the time of surgery. Clinical characteristics, except the status of preoperative biochemical tests (24 hr urine fractioned catecholamine or plasma-fractioned catecholamine) (p=0.020), preoperative hemodynamics, and medicine management and surgical approaches, in the three groups were comparable. Multivariate analyses demonstrated that the size of the tumor (p=0.034) was an independent risk factor for intraoperative hemodynamic instability. Among the three groups, we found no significant difference in intraoperative hemodynamics and postoperative outcomes. Conclusion The data from the current study indicated that the preoperative management of pheochromocytoma with single α-receptor blocker PXB for more than 2 weeks, after the final dose adjustment, could not further reduce the risk of intraoperative hemodynamic instability or postoperative complications. Thus, our study supports that 14 days would be enough for the duration of preoperative management of pheochromocytoma with single α-receptor blocker PXB in final dose.

Highlights

Pheochromocytoma, a rare catecholamine-producing tumor arises from chromaffin cells in the adrenal medulla and may cause a series of clinical manifestations, typically including hypertension, diaphoresis, and tachycardia [1, 2]
Prospective studies that analyze the impact of the duration of preoperative preparation with PXB on perioperative hemodynamic alterations and postoperative outcomes are lacking. erefore, we conducted the present study to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of single α-receptor blocker phenoxybenzamine
Intraoperative hemodynamic instability significantly increases the risk of major morbidity for patients with pheochromocytomas [9]

Summary

Introduction

Pheochromocytoma, a rare catecholamine-producing tumor arises from chromaffin cells in the adrenal medulla and may cause a series of clinical manifestations, typically including hypertension, diaphoresis, and tachycardia [1, 2]. Tumor manipulation during operation can trigger uncontrolled release of catecholamines that may lead to potentially lethal hypertensive crises and arrhythmias. This release of catecholamines can be seen in patients with normotensive and asymptomatic tumors [3]. Prospective studies that analyze the impact of the duration of preoperative preparation with PXB on perioperative hemodynamic alterations and postoperative outcomes are lacking. Erefore, we conducted the present study to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of single α-receptor blocker phenoxybenzamine Prospective studies that analyze the impact of the duration of preoperative preparation with PXB on perioperative hemodynamic alterations and postoperative outcomes are lacking. erefore, we conducted the present study to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of single α-receptor blocker phenoxybenzamine

Patients and Methods

Statistical Analysis

Result

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Disclosure