A Nomogram for Predicting Intraoperative Hemodynamic Instability in Patients With Pheochromocytoma

Abstract

PurposeSurgical removal of pheochromocytoma (PCC), including open, laparoscopic, and robot-assisted adrenalectomy, is the cornerstone of therapy, which is associated with high risk of intraoperative and postoperative life-threatening complications due to intraoperative hemodynamic instability (IHD). This study aims to develop and validate a nomogram based on clinical characteristics as well as computed tomography (CT) features for the prediction of IHD in pheochromocytoma surgery.MethodsThe data from 112 patients with pheochromocytoma were collected at a single center between January 1, 2010, and December 31, 2019. Clinical and radiological features were selected with the least absolute shrinkage and selection operator regression analysis to predict IHD then constitute a nomogram. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultsAge, tumor shape, Mayo Adhesive Probability score, laterality, necrosis, body mass index, and surgical technique were identified as risk predictors of the presence of IHD. The nomogram was then developed using these seven variables. The model showed good discrimination with a C-index of 0.773 (95% CI, 0.683–0.862) and an area under the receiver operating characteristic curve (AUC) of 0.739 (95% CI, 0.642–0.837). The calibration plot suggested good agreement between predicted and actual probabilities. Besides, calibration was tested with the Hosmer–Lemeshow test (P = 0.961). The decision curve showed the clinical effectiveness of the nomogram.ConclusionsOur nomogram based on clinical and CT parameters could facilitate the treatment strategy according to assessment of the risk of IHD in patients with pheochromocytoma.

Which surgical approach is more favorable for pheochromocytoma of different sizes (< 6 cm vs. ≥ 6 cm)? A single retrospective center experience

“…Some researchers have proposed that laparoscopic pheochromocytoma resection has more advantages than open surgery. However, intraoperative hemodynamics is a worrisome problem [ 25 ]. Thus, during this intricate maneuver, surgical expediency is pivotal to forestall undue tumor compression and traction.…”

Орфанні Ендокринні Захворювання: Сучасні Тенденції Хірургічного Лікування В Україні

“…За синдромів MEN хірургічне видалення пухлини повинно проводитися строго до операції на ЩЗ та/чи ПЩЗ, що пов'язано з високим ризиком інтрата післяопераційних ускладнень, які загрожують життю внаслідок гемодинамічної нестабільності. Ця ж рекомендація стосується й інших ендокринних синдромів, до складу яких поряд із ФЕО входять чи інші пухлини, чи такі стани, що потребують оперативного втручання [100,101]. Підготовка до адреналектомії з приводу ФЕО повинна включати стабілізацію артеріального тиску і медикаментозне пом'якшення перебігу кардіоміопатії, спричиненої ФЕО.…”

Robotic Left Adrenalectomy for Pheochromocytoma. Diagnosis, Workup, and Treatment

“…With an adequate preparation, the potential for perioperative hemodynamic instability can be minimized as much as possible, even though this issue cannot be entirely predictable. 2,4 In conclusion, close collaboration between surgeon, endocrinologist, and anesthesiologist are important to avoid and manage perioperative events in patients undergoing resection for pheochromocytoma. The robotic approach is a modern alternative to laparoscopic and open resection with excellent outcomes.…”