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01-03-2016

Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients

Authors: Laurent Brunaud, Phi-Linh Nguyen-Thi, Eric Mirallie, Marco Raffaelli, Menno Vriens, Pierre-Etienne Theveniaud, Myriam Boutami, Brendan M. Finnerty, Wessel M. C. M. Vorselaars, Inne Borel Rinkes, Rocco Bellantone, Celestino Lombardi, Thomas Fahey III, Rasa Zarnegar, Laurent Bresler

Published in: Surgical Endoscopy | Issue 3/2016

Abstract

Background

Since the 1950s, preoperative medical preparation has been widely applied in patients with pheochromocytoma to improve intraoperative hemodynamic instability and postoperative complications. However, advancements in preoperative imaging, laparoscopic surgical techniques, and anesthesia have considerably improved management in patients with pheochromocytoma. In consequence, there is no validated consensus on current predictive factors for postoperative morbidity. The aim of this study was to determine perioperative factors which are predictive for postoperative morbidity in patients undergoing laparoscopic adrenalectomy for pheochromocytoma.

Study design

It is a retrospective analysis of prospectively maintained databases in five medical centers from 2002 to 2013. Inclusion criteria were consecutive patients who underwent non-converted laparoscopic unilateral total adrenalectomy for pheochromocytoma.

Results

Two-hundred and twenty-five patients were included. All-cause and cardiovascular postoperative morbidity rates were 16 % (n = 36) and 4.8 % (n = 11), respectively. Preinduction blood pressure normalization after preoperative medical preparation had no impact on postoperative morbidity. However, past medical history of coronary artery disease (OR [CI95 %] = 3.39; [1.317–8.727]) and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 160 mmHg and MAP < 60 mmHg) (OR [CI95 %] = 3.092; [1.451–6.587]) remained independent predictors for postoperative all-cause morbidity. Similarly, past medical history of coronary artery disease (OR [CI95 %] = 14.41; [3.119–66.57]), female sex (OR [CI95 %] = 12.05; [1.807–80.31]), and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 200 mmHg and MAP < 60 mmHg) (OR [CI95 %] = 4.13; [1.009–16.90]) remained independent predictors for postoperative cardiovascular morbidity.

Conclusions

This study identifies risk factors for cardiovascular and all-cause postoperative morbidity after laparoscopic adrenalectomy in current clinical setting. These data can help physicians to guide intra-operative blood pressure management and have to be taken into account in further studies.

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Title: Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients
Authors: Laurent Brunaud
Phi-Linh Nguyen-Thi
Eric Mirallie
Marco Raffaelli
Menno Vriens
Pierre-Etienne Theveniaud
Myriam Boutami
Brendan M. Finnerty
Wessel M. C. M. Vorselaars
Inne Borel Rinkes
Rocco Bellantone
Celestino Lombardi
Thomas Fahey III
Rasa Zarnegar
Laurent Bresler
Publication date: 01-03-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4294-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients

Abstract

Background

Study design

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Study design

Results

Conclusions

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