Hemodynamic stability during adrenalectomy for pheochromocytoma

Abstract

Hemodynamic stability is one of the most critical aspects of adrenal surgery for pheochromocytoma. Few articles have evaluated the hemodynamic status of patients undergoing posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma. The aim of this study is to compare the intraoperative hemodynamic parameters between lateral transperitoneal adrenalectomy (TPA) and PRA in this groups of patients. This report describes a retrospective study of 53 pheochromocytoma patients who underwent endoscopic adrenalectomy via transperitoneal (22 patients) or posterior retroperitoneal (31 patients) approaches from January 2008 to March 2015. Data from these patients were compared to investigate the differences in hemodynamic parameters between the 2 approaches. Clinical parameters at presentation were similar between the 2 groups, except for tumor size, which was larger in the TPA group. The PRA group is associated with reduced operative time, blood loss, and length of hospital stay compared to TPA even after adjusting for the tumor size. There was greater BP fluctuations and higher maximum systolic and diastolic blood pressure (BP) within the TPA group compared to PRA during univariate analysis. This was however not significant after adjusting for tumor size. There was no difference in the intraoperative inotropic support requirement between the 2 groups. PRA is associated with stable intraoperative hemodynamic status, as well as favorable perioperative outcomes compared to TPA in patients with small pheochromocytomas.

Comparison of Posterior Retroperitoneoscopic Adrenalectomy Versus Lateral Transperitoneal Laparoscopic Adrenalectomy for Adrenal Tumors: A Systematic Review and Meta-Analysis

“…Among the seven studies on the EBL (11)(12)(13)(14)(15)(16)19), obvious heterogeneity was observed, so we applied random effect model to statistical analysis. Our final outcomes indicated statistically significant difference between PRA and LTA (MD: −15.17; 95% CI, −26.63 to −3.72; P = 0.009, Figure 2B).…”

“…The conversion rate was recorded in seven of nine researches (11)(12)(13)(14)(15)(16)(17). Since the heterogeneity test outcome (I 2 = 0%), we used fixed effects model.…”

“…We had done meta-analysis of perioperative complication (11,12,(14)(15)(16)(17)19). Based on the heterogeneity test, fixed effect models were used.…”

Minimally Invasive Adrenal Surgery

“…Several studies have compared the surgical outcomes of LTA and PRA. These reports demonstrated clinically equivalent outcomes, with a smaller tumor size, less estimated blood loss (EBL), a shorter time to oral intake, and a shorter length of hospital stay in the PRA group ( Table 1 ) [ 19 , 21 – 28 ]. A recent meta-analysis reported significant differences in demographic characteristics and surgical outcomes between LTA and PRA groups.…”

“…Therefore, the treatment of smaller tumors is more likely to be successful with this posterior approach. Several studies have reported that tumors smaller than 8 cm could be safely removed by the PRA technique, so larger tumors (with a size exceeding approximately 8 cm) are more usually removed by LTA [ 21 ]. Because of selection bias, tumor size might have played a role as a confounding factor regarding the tendency for a shorter operation time, less EBL, a shorter time to oral intake, and a shorter length of hospital stay in PRA.…”