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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2016

01-07-2016

Preoperative risk factors of hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma

Authors: Sébastien Gaujoux, Stéphane Bonnet, Claude Lentschener, Jean-Marc Thillois, Denis Duboc, Jérôme Bertherat, Charles Marc Samama, Bertrand Dousset

Published in: Surgical Endoscopy | Issue 7/2016

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Abstract

Background

Adrenalectomy for pheochromocytoma is considered to be a challenging procedure because of the risk of hemodynamic instability (HI), which is poorly defined and unpredictable. The objective of this retrospective study from a prospectively maintained database was to determine the predictive factors for perioperative HI, which is defined as a morbidity-related variable, in patients undergoing unilateral laparoscopic adrenalectomy (LA) for pheochromocytoma.

Methods

A total of 149 patients with unilateral pheochromocytoma undergoing LA were included. First, HI was defined using independent hemodynamic variables associated with perioperative morbidity. Next, a multivariable logistic regression analysis was performed to determine the independent preoperative risk factors for HI.

Results

There was no postoperative mortality, and the overall morbidity rate was 10.7 %. The use of a cumulative dose of norepinephrine >5 mg was the only independent hemodynamic predictive factor for postoperative complications; thus, this variable was used to define HI. A multivariate analysis revealed that a symptomatic high preoperative blood pressure (p = 0.003) and a ten-fold increase in urinary metanephrine and/or normetanephrine levels (p < 0.0001) were significant predictors of HI. When no predictive factors were present, the risk of HI and the postoperative morbidity were 1.5 and 4.3 %, respectively. However, when two predictive factors were present, the HI risk and the postoperative morbidity were 53.8 and 30.8 %, respectively.

Conclusion

Perioperative HI, defined as the need for a cumulative dose of norepinephrine >5 mg, is significantly associated with postoperative morbidity and can be predicted by symptomatic preoperative high blood pressure and above a ten-fold increase in urinary metanephrine and/or normetanephrine levels.
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Metadata
Title
Preoperative risk factors of hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma
Authors
Sébastien Gaujoux
Stéphane Bonnet
Claude Lentschener
Jean-Marc Thillois
Denis Duboc
Jérôme Bertherat
Charles Marc Samama
Bertrand Dousset
Publication date
01-07-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4587-x

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