H Groeben1, M K Walz2, B J Nottebaum1, P F Alesina2, A Greenwald3, R Schumann4, M W Hollmann5, L Schwarte6, M Behrends7, T Rössel8,9, C Groeben8,9, M Schäfer10, A Lowery11, N Hirata12, M Yamakage12, J A Miller13, T J Cherry13, A Nelson14, C C Solorzano15, B Gigliotti16, T S Wang17, J K G Wietasch18, P Friederich19, B Sheppard20, P H Graham21, T N Weingarten22, J Sprung22. 1. Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Essen, Germany. 2. Department of Minimally and General Surgery, Kliniken Essen-Mitte, Essen, Germany. 3. Department of Anaesthesiology, Columbia University, New York. 4. Department of Anaesthesiology, Tufts Medical Center, Boston, Massachusetts. 5. Department of Anaesthesiology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands. 6. VU University Medical Centre Amsterdam, Amsterdam, the Netherlands. 7. Department of Anaesthesiology and Perioperative Medicine, University of California, San Francisco, California. 8. Department of Anaesthesiology and Intensive Care Medicine, Carl-Gustav Carus University Hospital Dresden, Dresden, Germany. 9. Department of Urology, Carl-Gustav Carus University Hospital Dresden, Dresden, Germany. 10. Department of Anaesthesiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 11. Discipline of Surgery, School of Medicine, University of Ireland, Galway, Ireland. 12. Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan. 13. Endocrine Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 14. Department of Anaesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois. 15. Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, Tennessee. 16. Department of General and Endocrine Surgery, Harvard Medical School, Boston, Massachusetts. 17. Division of Surgical Oncology - Endocrine Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 18. Department of Anaesthesiology, University of Groningen, Groningen, the Netherlands. 19. Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Klinikum Bogenhausen, Munich, Germany. 20. Department of Surgery, Oregon Health and Science University, Portland, Oregon. 21. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston. 22. Department of Anaesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Abstract
BACKGROUND: Surgery for catecholamine-producing tumours can be complicated by intraoperative and postoperative haemodynamic instability. Several perioperative management strategies have emerged but none has been evaluated in randomized trials. To assess this issue, contemporary perioperative management and outcome data from 21 centres were collected. METHODS: Twenty-one centres contributed outcome data from patients who had surgery for phaeochromocytoma and paraganglioma between 2000 and 2017. The data included the number of patients with and without α-receptor blockade, surgical and anaesthetic techniques, complications and perioperative mortality. RESULTS: Across all centres, data were reported on 1860 patients with phaeochromocytoma or paraganglioma, of whom 343 underwent surgery without α-receptor blockade. The majority of operations (78·9 per cent) were performed using minimally invasive techniques, including 16·1 per cent adrenal cortex-sparing procedures. The cardiovascular complication rate was 5·0 per cent overall: 5·9 per cent (90 of 1517) in patients with preoperative α-receptor blockade and 0·9 per cent (3 of 343) among patients without α-receptor blockade. The mortality rate was 0·5 per cent overall (9 of 1860): 0·5 per cent (8 of 517) in pretreated and 0·3 per cent (1 of 343) in non-pretreated patients. CONCLUSION: There is substantial variability in the perioperative management of catecholamine-producing tumours, yet the overall complication rate is low. Further studies are needed to better define the optimal management approach, and reappraisal of international perioperative guidelines appears desirable.
BACKGROUND: Surgery for catecholamine-producing tumours can be complicated by intraoperative and postoperative haemodynamic instability. Several perioperative management strategies have emerged but none has been evaluated in randomized trials. To assess this issue, contemporary perioperative management and outcome data from 21 centres were collected. METHODS: Twenty-one centres contributed outcome data from patients who had surgery for phaeochromocytoma and paraganglioma between 2000 and 2017. The data included the number of patients with and without α-receptor blockade, surgical and anaesthetic techniques, complications and perioperative mortality. RESULTS: Across all centres, data were reported on 1860 patients with phaeochromocytoma or paraganglioma, of whom 343 underwent surgery without α-receptor blockade. The majority of operations (78·9 per cent) were performed using minimally invasive techniques, including 16·1 per cent adrenal cortex-sparing procedures. The cardiovascular complication rate was 5·0 per cent overall: 5·9 per cent (90 of 1517) in patients with preoperative α-receptor blockade and 0·9 per cent (3 of 343) among patients without α-receptor blockade. The mortality rate was 0·5 per cent overall (9 of 1860): 0·5 per cent (8 of 517) in pretreated and 0·3 per cent (1 of 343) in non-pretreated patients. CONCLUSION: There is substantial variability in the perioperative management of catecholamine-producing tumours, yet the overall complication rate is low. Further studies are needed to better define the optimal management approach, and reappraisal of international perioperative guidelines appears desirable.
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