Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma

Abstract

Severe hyperlactatemia (SH)/lactic acidosis (LA) after laparoscopic resection of pheochromocytoma is an infrequently reported complication. The study aims to investigate the incidence of this complication and to determine the clinical risk factors. Patients who underwent laparoscopic resection for pheochromocytoma between 2011 and 2014 at Peking Union Medical College Hospital were enrolled. LA was defined as pH < 7.35, bicarbonate <20 mmol/L, and serum lactate ≥5 mmol/L; SH as lactate ≥5 mmol/L; and moderate hyperlactatemia (MH) as lactate 2.5–5.0 mmol/L without evidence of acidosis (pH > 7.35 and/or bicarbonate >20 mmol/L). Data concerning patient demographics, clinical history, and laboratory results were collected and statistical analyses were performed. Out of 145 patients, 59 (40.7%) developed post-operative hyperlactatemia. The incidences of MH and SH/LA were 25.5% and 15.2%, respectively. Multivariate analysis demonstrated that body mass index (BMI) (odds ratio [OR], 1.204; 95% confidence interval [CI], 1.016–1.426), 24-hour urine epinephrine concentration (OR, 1.012; 95% CI, 1.002–1.022), and tumor size (OR, 1.571; 95% CI, 1.102–2.240) were independent predictors of post-operative SH/LA. The data show that post-operative SH/LA is not a rare complication after pheochromocytoma resection and may be closely associated with higher BMI, larger tumor size, and higher levels of urine epinephrine.

Nonselective Compared With Selective α-Blockade Is Associated With Less Intraoperative Hypertension in Patients With Pheochromocytomas and Paragangliomas: A Retrospective Cohort Study With Propensity Score Matching

“…The proportion of patients who received β-blockade in different studies varied from 26.0% to 96.3% due to different types of α-blockade, the threshold of HR control, and patient populations. 13 , 15 , 18 , 30 , 36 , 37 In a systematic review, van der Zee and de Boer 11 found that the use of phenoxybenzamine was often accompanied by a β-blocker to control reflex tachycardia when compared with doxazosin. In the present study, patients with nonselective α-blockade received more β-blockade therapy before and during surgery, but the differences no longer existed after propensity score matching.…”

“…From the available evidence, it seems that Chinese patients received less β-blockade to control the HR before surgery than Western patients. 13 , 15 , 18 , 30 , 36 , 37 …”

Glucose Metabolism in Cancer: The Warburg Effect and Beyond

“…In seeking a target that was more unique to cancer cell metabolism and central to the Warburg effect, Le et al focused on lactate dehydrogenase A (LDHA) which reciprocally mediates the redox-coupled conversion between lactate with NAD+ and pyruvate with NADH [67,68]. Elevated expression level of LDHA is a hallmark of many types of tumors, including squamous head and neck cancer, colorectal cancer, and nonsmall cell lung cancer [69][70][71].…”

Factors affecting a persistent increase in the perioperative lactate levels in colorectal cancer surgery and its impact on postoperative outcomes

“…This result varies between studies. In the study of Naik et al 11 , female patients found a risk factor (p = 0.011) for intraoperative hyperlactatemia, while the research of Wu et al 12 and also the study of Lawton et al 13 gender did not have a significant prediction for high lactate.…”

“…According to our study, obesity was an independent risk factor for hyperlactatemia in accordance with the literature. 12 Increased circulating fatty acids released from adipocytes, which are more in obese patients, adversely affect the glucose utilization of the muscles. It also provokes insulin resistance in tumor necrosis factor-α produced by adipocytes.…”