Wessel M C M Vorselaars1, Emily L Postma2, Eric Mirallie3, Julien Thiery3, Mattan Lustgarten4, Jesse D Pasternak4, Rocco Bellantone5, Marco Raffaelli5, Thomas Fahey6, Menno R Vriens1, Laurent Bresler7, Laurent Brunaud7, Rasa Zarnegar8. 1. Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 2. Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Endocrine and Minimally Invasive Surgery, Weill Cornell Medical College, New York, NY. 3. Department of Digestive and Endocrine Surgery, CHU Nantes, Nantes, France. 4. Department of Surgery, University of Toronto, Toronto, Canada. 5. Division of Endocrine and Metabolic Surgery, Istituto di Semiotica Chirurgica, Universita Cattolica del Sacro Cuore Policlinico "A Gemelli", Rome, Italy. 6. Department of Endocrine and Minimally Invasive Surgery, Weill Cornell Medical College, New York, NY. 7. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy-Hospital Brabois Adultes, Nancy, France. 8. Department of Endocrine and Minimally Invasive Surgery, Weill Cornell Medical College, New York, NY. Electronic address: raz2002@med.cornell.edu.
Abstract
BACKGROUND: Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort. METHODS: Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator. RESULTS: In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134-34.235, P = .035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions. CONCLUSION: Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.
BACKGROUND: Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort. METHODS: Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator. RESULTS: In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134-34.235, P = .035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions. CONCLUSION: Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.
Authors: Uriel Clemente-Gutiérrez; Rafael H Pérez-Soto; Juan D Hernández-Acevedo; Nicole M Iñiguez-Ariza; Enrique Casanueva-Pérez; Juan Pablo Pantoja-Millán; Mauricio Sierra-Salazar; Miguel F Herrera; David Velázquez-Fernández Journal: Langenbecks Arch Surg Date: 2021-06-23 Impact factor: 3.445
Authors: Magdalena Pisarska-Adamczyk; Karolina Zawadzka; Krzysztof Więckowski; Krzysztof Przęczek; Piotr Major; Michał Wysocki; Piotr Małczak; Michał Pędziwiatr Journal: Gland Surg Date: 2021-03