Presentation and surgery outcomes in elderly with pheocromocytoma: a comparative analysis with young patients

Abstract

Purpose:To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma.Patients and Methods:A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients >60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (<60 years old).Results:The mean (±standard deviation) age in the older (n=10) and younger (n=36) groups was 69.6±5.3 years and 34.0±12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Postoperatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1±2.8 versus 1.4±1.0 days; p=0.014), more clinical complications (60% versus 18.9%; p=0.01), and longer hospital stay (10.2±8.4 versus 5.7±4.9 days; p=0.028).Conclusions:Although all patients received the same preoperative preparation, the elderly group exhibited a slower and more complicated recovery after adrenalectomy. Meticulous perioperative care should be used in the elderly when treating phaeochromocytoma; nevertheless, adrenalectomy is a relatively safe procedure in this patient population.

Predictors of complication after adrenalectomy

“…In accordance to our findings it has been shown that age and comorbidities have major influence in post-operative recovery (2, 11, 16, 17). Contemporary guidelines recommend a series of measures able to effectively minimize clinical complications, particularly in cases of Cushing syndrome, pheochromocytoma and ACC (18).…”

“…The knowledge regarding adrenal diseases evolved and consequently the associated morbidity decreased. Currently, post-operative morbidity rate in patients with Cushing syndrome is approximately 6% and mortality rate in patients with pheocromocytoma diminished to 0% to 2.9% (11). Murphy et al reported a complication rate of 7.2% in nationwide cohort with >40.000 subjects that underwent adrenalectomy due to a variety of pathologies (2).…”

“…Generally, patients with indication for adrenalectomy will be more prejudicated by their adrenal disease than by the potential harms of operation and thus, we cannot afford to spare most individuals from surgery. Diligent thromboembolism prophylaxis, pulmonary rehabilitation and preclusion of bowel preparation are advocated, especially in elderly, in whom the physiologic response to surgical stress is impaired (11).…”

Is Laparoscopic Adrenalectomy for Pheochromocytoma a Safe and Effective Surgery in Geriatric Patients?

“…Bruynzeel et al reported that age was not associated with hemodynamic instability during surgery of PHEO; however, in this study, laparoscopic and open surgeries were included and patients were not stratified by age (18). Similarly, Srougi et al reported that being older than 60 years did not affect hemodynamic instability; however, their study included open and laparoscopic adrenalectomies and also partial and bilateral adrenalectomies (8). In this context, our study differs from previous reports by analyzing the pure laparoscopic and complete resections between elder and young patients.…”

“…Nowadays, with the increase in life expectancy and advancements in imaging technology, there has been an increase in the diagnosis of PHEO in elderly patients who undergo routine check-ups (7). However, elderly patients are physically more delicate than youngers, and the outcomes of laparoscopic surgery may be considered going to be worse than younger due to hemodynamic instability during operation (8). In this study, we aimed to compare the LA outcomes in elderly and young PHEO patients.…”