Adrenalectomy for Pheochromocytoma: Complications and Predictive Factors of Intraoperative Hemodynamic Instability

Abstract

Background Surgery is the treatment of choice for pheochromocytoma. However, this surgery carries a risk of hemodynamic instability (HDI). The aim of this study was to report complications associated with this procedure, to identify risk factors for HDI during surgery, and its impact on postoperative outcomes. Methods The charts of all patients who underwent adrenalectomy for pheochromocytoma in two academic centers between 2006 and 2020 were retrospectively reviewed. The primary outcome was HDI defined by a systolic blood pressure >160 mmHg or a mean blood pressure <60 mmHg intraoperatively. The secondary outcomes of interest were the total duration of HDI, the occurrence of intraoperative arrhythmia, perioperative cardiovascular events, and postoperative complications. Results 205 patients were included. HDI occurred intraoperatively in 155 patients (75.6%) but only 6 (3.2%) experienced arrhythmia. Thirty-eight postoperative complications were reported (18.6%) but only nine were ≥3 according to Clavien-Dindo (4.4%). There were 10 postoperative cardiovascular events (5.7%). Patients with intraoperative HDI had higher rates of postoperative complications (21.3% vs 10%; P = .07), major postoperative complications (5.8% vs 0%; P = .12) and cardiovascular events (6.5% vs 0%; P = .12). Factors associated with intraoperative HDI in univariate analysis were age (OR = 8.14; P = .006), high blood pressure preoperatively (OR = 2.16; P = .04), tumor size (OR = 15.83; P = .0001), and urinary normetanephrine level (OR = 9.33; P = .04). Discussion In multidisciplinary centers, the overall morbidity of adrenalectomy for pheochromocytoma is low. HDI during adrenalectomy for pheochromocytoma is highly prevalent but rarely associated with major cardiovascular events. There might be a link between HDI and postoperative cardiovascular events.

Indications for laparoscopic adrenalectomy as a determinant of the perioperative and postoperative course: a retrospective, single-centre cohort study

“…However, we did not observe any significant 30-day complications in these cases. The average rate of perioperative complications of LA reported in the literature ranges from 0 to 18.6%, with bleeding being the most frequent complication [2,8,20,26,27,29,30]. The observed complication rate of 5.6% in our analysis is in line with the above studies.…”

“…Taking into consideration the variety of indications for LA in this heterogenous group of patients, the essential role of the multidisciplinary team, including urologists, surgeons, endocrinologists, and anaesthesiologists, in the qualification of patients for surgery should be emphasized. This refers particularly to a group of patients with pheochromocytoma, who are at high risk of intraoperative haemodynamic instability [10,20,21]. The cooperation of the multidisciplinary team minimized the cardiovascular 30-day complications (1.4%) and contributed to the survival of all operated patients (mortality rate 0%).…”

Long-term Persistent Hypertension after Pheochromocytoma and Paraganglioma Resection: A Multi-Center Study

“…Most studies on HDI in PPGL have focused on predicting risk factors for its occurrence 14,[28][29][30][31][32] . This study rst found the association between HDI and long-term persistent hypertension in PPGL patients after surgery.…”

Preoperative α-blockade versus no blockade for pheochromocytoma–paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis

“…However, the extent of their correlations remains doubtful, considering the profound evolvement of diagnostic modalities, anesthetic monitoring, as well as surgical approaches. Recent studies indicated that despite optimal α-blockade, intraoperative hemodynamic fluctuations were still common but rarely associated with major cardiovascular events 12 , 13 . Prolonged α-blockade predicted more perioperative hypotension episodes 14 .…”