Risk Factors for Perioperative Hemodynamic Instability in Pheochromocytoma: A Systematic Review and Meta-Analysis

Abstract

Objective: To evaluate the risk factors of perioperative hemodynamic instability in pheochromocytoma, we conducted a systematic search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analysis. Methods: In April 2021, we systematically searched PubMed, the Cochrane library, and Scopus for relevant studies on the risk factors of perioperative hemodynamic instability of adrenalectomy in patients with pheochromocytoma, and we subjected the findings from those studies to formal meta-analysis. Results: Our systematic review identified 14 studies involving 1725 patients, of which nine studies with 967 patients were eligible for meta-analysis. The results of meta-analysis showed that tumor size (odds ratio (OR): 1.14 for each increased cm, 95% confidence interval (CI) 1.03–1.26, z = 2.57)) and urinary norepinephrine (OR, 1.51: 95% CI 1.26–1.81; z = 4.50) were most closely associated with the occurrence of perioperative hemodynamic instability. Conclusion: These findings suggest that tumor size and urinary norepinephrine are important predictors and risk factors for perioperative hemodynamic instability in adrenalectomy for pheochromocytoma. Such findings may be of value to surgeons and anesthesiologists when considering or preparing for this procedure.

Management of Patients with Treatment of Pheochromocytoma: A Critical Appraisal

“…In addition, another remaining problem is that the definition of an episode of intraoperative hemodynamic instability is not consensual in the available literature ( Table 2 ). In a recent systematic review investigating risks factors for perioperative hemodynamic instability in pheochromocytoma regrouping 14 studies involving 1725 patients, there were 14 different definitions for intraoperative hemodynamic instability [ 46 ]. This demonstrates the lack of uniformity in the scientific community and the strain of comparing studies using different definitions for intraoperative hemodynamic instability.…”

“…In a systematic study, tumor size and levels of urinary norepinephrine were associated with perioperative hemodynamic instability [ 46 ]. However, the use of alpha-blocking agents for preparation was not associated with intraoperative hemodynamic instability [ 46 ].…”

“…In a systematic study, tumor size and levels of urinary norepinephrine were associated with perioperative hemodynamic instability [ 46 ]. However, the use of alpha-blocking agents for preparation was not associated with intraoperative hemodynamic instability [ 46 ]. On the contrary, Kierman et al used the definition of SBP > 200 mhg, use of vasoactive drugs and heart rate (HR) > 110 bpm for intraoperative hemodynamic instability [ 49 ].…”

Risk factors for hemodynamic instability during laparoscopic resection of pheochromocytoma

“…Numerous other risk factors for HI were reported in the literature, including plasma or urinary level of catecholamine, BMI, clinical symptoms and et al [ 3 , 9 , 23 , 24 ]. Possible reasons for this variability might be a lack of standardized perioperative anaesthesiological and surgical management.…”

Anesthesia and Outcome of 33 Surgeries in 24 Multiple Endocrine Neoplasia Type 2A (MEN2A) Patients: A National Rare Disease Center’s Experience

“…Another retrospective study including 61 patients who had undergone pheochromocytoma resection concluded that intraoperative hypertension episodes were similar in MEN2A patients to those in nonsyndromic pheochromocytoma patients, with postoperative hypotension less frequent and severe ( 15 ). However, for MEN2A patients undergoing pheochromocytoma resection, preoperative medications, including phenoxybenzamine or other selective a1-adrenergic blockers, are necessary, and intraoperative hemodynamic instability can be predicted according to their clinical manifestations, laboratory examination and tumor size ( 11 , 15 , 16 ).…”