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01-02-2021 | ß-Blockers

Pheochromocytoma surgery without systematic preoperative pharmacological preparation: insights from a referral tertiary center experience

Authors: Cyrille Buisset, Carole Guerin, Pierre-Julien Cungi, Mickael Gardette, Nunzia-Cinzia Paladino, David Taïeb, Thomas Cuny, Frederic Castinetti, Frederic Sebag

Published in: Surgical Endoscopy | Issue 2/2021

Abstract

Background

Despite significant advances in imaging and genetics, as well as surgical and anesthetic innovations, morbidity in pheochromocytoma surgery remains significant. The aim of this study was to identify the predictive factors of global and cardiovascular morbidity following unilateral laparoscopic adrenalectomy for pheochromocytoma.

Methods

We conducted a retrospective study from a unicentric cohort. All patients who underwent non-converted laparoscopic unilateral adrenalectomy for pheochromocytoma between 2000 and 2017 were included. Our patients did not systematically benefit from preoperative pharmacological preparation. It is to be noted that they never received alpha-blockers. Preoperative, intraoperative, and postoperative data during follow-ups were collected. Univariate and multivariate analyses by logistic regression were performed.

Results

A total of 134 patients were included. Fifty-three percent of patients did not receive preoperative pharmacological preparation (PPP) and 33% neither preoperative antihypertensives nor PPP before surgery. There was no postoperative mortality. The global morbidity was 13.4%, while cardiovascular morbidity was 4.5%. The main factors associated with global morbidity were preoperative diuretics, a medical history of stroke, and the need for pressor amines postoperatively. The main factor associated with cardiovascular morbidity was the need for pressor amines postoperatively. Predictive factors of postoperative need for pressor amines for hypotension were the tumor size, preoperative beta-blockers, and/or diuretics.

Conclusion

In this large cohort of patients, our data revealed no mortality and low global and cardiovascular morbidity rates, showing that pheochromocytoma surgery without systematic PPP and even without preoperative antihypertensives is feasible and safe for selected patients. Our data also highlight the need for a good preoperative evaluation of the patient and the tumor, in order to optimize treatments and to help the detection of high-risk patients. This also allows us to better prevent and anticipate their possible complications.

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Title: Pheochromocytoma surgery without systematic preoperative pharmacological preparation: insights from a referral tertiary center experience
Authors: Cyrille Buisset
Carole Guerin
Pierre-Julien Cungi
Mickael Gardette
Nunzia-Cinzia Paladino
David Taïeb
Thomas Cuny
Frederic Castinetti
Frederic Sebag
Publication date: 01-02-2021
Publisher: Springer US
Keywords: ß-Blockers
Diuretics
Hypotension
Adrenalectomy
Adrenalectomy
Hypotension
Published in: Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07439-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pheochromocytoma surgery without systematic preoperative pharmacological preparation: insights from a referral tertiary center experience

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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