Marta Araujo-Castro1,2, Rogelio García Centero3, María-Carmen López-García4, Cristina Álvarez Escolá5, María Calatayud Gutiérrez6, Concepción Blanco Carrera7, Paz De Miguel Novoa8, Nuria Valdés Gallego9, Felicia A Hanzu10, Paola Gracia Gimeno11, Mariana Tomé Fernández-Ladreda12, Juan Carlos Percovich Hualpa3, Mireia Mora Porta10, Javier Lorca Álvaro13, Héctor Pian14, Ignacio Ruz Caracuel14, Alfonso Sanjuanbenito Dehesa15, Victoria Gómez Dos Santos13, Ana Serrano Romero16, Cristina Lamas Oliveira4. 1. Neuroendocrinology Unit. Department of Endocrinology & Nutrition. Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain. marta.araujo@salud.madrid.org. 2. Department of Health Science, Universidad de Alcalá, Madrid, Spain. marta.araujo@salud.madrid.org. 3. Department of Endocrinology & Nutrition, Hospital Gregorio Marañón, Madrid, Spain. 4. Department of Endocrinology & Nutrition, Hospital Universitario de Albacete, Albacete, Spain. 5. Department of Endocrinology & Nutrition, Hospital La Paz, Madrid, Spain. 6. Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain. 7. Department of Endocrinology & Nutrition, Hospital Príncipe de Asturias, Madrid, Spain. 8. Department of Endocrinology & Nutrition, Hospital Clínico San Carlos, Madrid, Spain. 9. Department of Endocrinology & Nutrition, Hospital de Universitario de Cabueñes, Asturias, Spain. 10. Department of Endocrinology & Nutrition & Group of Endocrine Disorders. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain. 11. Department of Endocrinology & Nutrition, Hospital Royo Villanova, Zaragoza, Spain. 12. Department of Endocrinology & Nutrition, Hospital Universitario de Puerto Real (Cádiz), Cádiz, Spain. 13. Department of Urology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain. 14. Department of Pathology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain. 15. Department of General Surgery, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain. 16. Department of Anesthesia, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain.
Abstract
PURPOSE: To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery. METHODS: A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale. RESULTS: One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P = 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82, P < 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n = 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. CONCLUSION: Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications.
PURPOSE: To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery. METHODS: A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale. RESULTS: One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P = 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82, P < 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n = 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. CONCLUSION: Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications.
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Authors: C Mínguez Ojeda; V Gómez Dos Santos; J Álvaro Lorca; I Ruz-Caracuel; H Pian; A Sanjuanbenito Dehesa; F J Burgos Revilla; M Araujo-Castro Journal: J Endocrinol Invest Date: 2022-06-24 Impact factor: 5.467