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Habeeb TAAM, Araujo-Castro M, Chiaretti M, Podda M, Aiolfi A, Kryvoruchko IA, Manangi MN, Shelat V, Kalmoush AE, Labib MF, Elshafey MH, Ibrahim SMM, Abo Alsaad MI, Elbelkasi H, Mansour MI, Elshahidy TM, Heggy IA, Elsayed RS, Fiad AA, Yehia AM, Yassin MA, Elballat MR, Hebeishy MH, AboZeid AK, Saleh MAA, Hamed AEM, Abdelghani AA, Mousa B. Side-specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study. Surg Endosc 2024; 38:4571-4582. [PMID: 38951238 PMCID: PMC11289338 DOI: 10.1007/s00464-024-10974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA). METHODS We retrospectively analyzed two hundred and seventy-one patients aged > 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included. RESULTS Intraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p < 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147-27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996-30.38, p < 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323-47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07-1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other. CONCLUSION LRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI.
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Affiliation(s)
- Tamer A A M Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Marta Araujo-Castro
- Neuroendocrinology & Adrenal Unit of the Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
| | - Massimo Chiaretti
- Department of General Surgery Specialties and Organ Transplant, Faculty of Pharmacy and Medicine, Sapienza Rome University, Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Milan, Italy
| | - Igor A Kryvoruchko
- Surgery Department #2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Mallikarjuna N Manangi
- Department of General Surgery, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Vishal Shelat
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Mohamed Fathy Labib
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | | | | | | | | | | | - Ibrahim A Heggy
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rasha S Elsayed
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa A Fiad
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Yehia
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud R Elballat
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed H Hebeishy
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Khaled AboZeid
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Abd Elwahab M Hamed
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amr A Abdelghani
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Bassam Mousa
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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de la Fouchardière C, Haissaguerre M, Decaussin-Petrucci M, Renaudin K, Deschamps F, Mirallié E, Murez T, Pattou F, Rocher L, Savoie PH, Faron M, Taieb D, Tabarin A, Bertherat J, Gimenez-Roqueplo AP, Amar L, Baudin E, Libé R. [French recommendations for malignant pheochromocytomas and paragangliomas by the national ENDOCAN-COMETE network]. Bull Cancer 2023; 110:1063-1083. [PMID: 37573200 DOI: 10.1016/j.bulcan.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, developed respectively in the adrenal medulla and in extra-adrenal locations. Their malignancy is defined by the presence of distant metastases. Forty percent of them are inherited and can be part of different hereditary syndromes. Their management is ensured in France by the multidisciplinary expert centers of the ENDOCAN-COMETE national network "Cancers of the Adrenal gland", certified by the National Cancer Institute and discussed within multidisciplinary team meetings. The diagnostic and therapeutic work-up must be standardized, based on an expert analysis of clinical symptoms, hormonal biological secretions, genetics, morphological and specific metabolic imaging. In the context of a heterogeneous survival sometimes beyond seven to ten years, therapeutic intervention must be justified. This is multidisciplinary and relies on surgery, interventional radiology, external or internal radiotherapy and medical treatments such as sunitinib or dacarbazine and temodal chemotherapy. The personalized approach based on functional imaging fixation status and genetics is progressing despite the extreme rarity of this disease.
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Affiliation(s)
| | - Magalie Haissaguerre
- CHU de Bordeaux, hôpital Haut Lévêque, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Pessac, France
| | | | - Karine Renaudin
- CHU de Nantes, hôpital Hôtel-Dieu, anatomo-pathologie, Nantes, France
| | - Fréderic Deschamps
- Gustave-Roussy Cancer Campus, département de radiologie interventionnelle, Villejuif, France
| | - Eric Mirallié
- CHU de Nantes, hôpital Hôtel-Dieu, chirurgie cancérologique, digestive et endocrinienne, Institut des maladies de l'appareil digestif, Nantes, France
| | - Thibaut Murez
- CHU de Montpellier, département d'urologie et transplantation rénale, Montpellier, France
| | - François Pattou
- CHRU de Lille, département de chirurgie endocrinienne et métabolique, Lille, France
| | - Laurence Rocher
- Université Paris-Saclay, BIOMAPS, hôpital Antoine-Béclère, service de radiologie, Clamart, France
| | - Pierre-Henri Savoie
- Hôpital d'instruction des Armées Sainte-Anne, service d'urologie, Toulon, France
| | - Matthieu Faron
- Gustave-Roussy Cancer Campus, service de chirurgie viscérale oncologique, Villejuif, France
| | - David Taieb
- La Timone University Hospital, CERIMED, Aix-Marseille University, département de médecine nucléaire, Marseille, France
| | - Antoine Tabarin
- CHU de Bordeaux, hôpital Haut Lévêque, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Pessac, France
| | - Jérôme Bertherat
- Hôpital Cochin, CHU de Paris-Centre, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Paris, France
| | | | - Laurence Amar
- Hôpital européen Georges-Pompidou, service d'hypertension artérielle, Paris, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus, service de cancérologie endocrine, centre coordonnateur ENDOCAN-COMETE, Villejuif, France
| | - Rossella Libé
- Hôpital Cochin, CHU de Paris-Centre, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Paris, France.
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Păun SC, Tănase I, Stoica B, Mirică A, Păun DL. Tips and Tricks in Laparoscopic Adrenalectomy for Pheochromocytoma. How We Do It. ROMANIAN JOURNAL OF MILITARY MEDICINE 2023. [DOI: 10.55453/rjmm.2023.126.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
"Pheochromocytomas are rare neuroendocrine tumors that frequently have genetic involvement and can present a particular risk in terms of the anesthetic-surgical procedure. Current worldwide medical recommendations state that laparoscopic adrenalectomy is the conventional treatment for pheochromocytoma, however, the ideal surgical strategy is still being developed as specialized surgeons gain experience with these rare tumors. The study's purpose was to thoroughly evaluate our film library and identify the best surgical steps that represent our standardized procedure. We developed a comprehensive set of surgical critical strategies for either a left or right adrenalectomy, providing helpful advice on patient positioning, port placement, the adrenal gland approach, as well as other surgical methods specifically designed for tumor mobilization and dissection. The current paper aims to synthesize our clinical experience in terms of preoperative preparation, patient positioning, intraoperative complications, causes of conversion, and specimen extraction. The main conclusions concern both the best surgical approach and the importance of surgical experience in the clinical management of these rare tumor types. "
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Hou Q, Zhang B, Luo Y, Wang P, Yang S, Shang P. Predictive Factors for Conversion from Laparoscopic Adrenalectomy to Open Surgery: A 9-Year Review of 911 Cases. J Laparoendosc Adv Surg Tech A 2023; 33:38-43. [PMID: 35617700 DOI: 10.1089/lap.2022.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: With the development of minimally invasive techniques, laparoscopic adrenalectomy (LA) has become the standard for the treatment of adrenal surgical diseases, but conversion to open adrenalectomy (OA) is also necessary in some cases. The purpose of this study was to investigate the risk factors for conversion from LA to OA. Methods: A retrospective study was performed on 911 patients who were diagnosed with adrenal tumors and underwent LA in the Department of Urology, Second Hospital of Lanzhou University from January 2013 to December 2021. According to the surgical methods, the patients were divided into the laparoscopic group (n = 873) and the conversion group (n = 38). Logistic regression was used to analyze the independent risk factors of conversion, and the logistic regression equation was established to predict the probability of conversion. Results: In this study, 38 patients (4.17%) were converted to open. In the univariate analysis, body mass index (P = .037), tumor side (P < .001), tumor size (P < .001), surgical approach (P < .001), and histological type (P = .006) were significantly associated with conversion. In the multivariate analysis, tumor diameter >7 cm (odds ratio = 2.835, 95% confidence interval 1.096-7.335; P = .032), transabdominal approach (odds ratio = 2.400, 95% confidence interval 1.136-5.074; P = .022), pheochromocytoma (odds ratio = 5.018, 95% confidence interval 1.964-12.822; P = .001), and malignant tumor (odds ratio = 17.781, 95% confidence interval 4.156-76.075; P < .001) were independent risk factors for transition opening. The logistic regression equation showed good power to predict conversion. Conclusion: Tumor size, surgical approach, and histological type were predictive factors for conversion from a laparoscopic to an open procedure. Preoperative evaluation of these characteristics is of great value for clinicians to evaluate the risk of conversion and make a surgical plan. It can not only reduce the conversion rate but also help to improve the intraoperative situation and shorten the length of hospital stays.
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Affiliation(s)
- Qian Hou
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Biao Zhang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yao Luo
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Pengyuan Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Shujun Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
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Savoie PH, Murez T, Neuville P, Van Hove A, Rocher L, Fléchon A, Camparo P, Ferretti L, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines Update 2022-2024: Adrenal tumor - Assessment of an adrenal incidetaloma and oncological management. Prog Urol 2022; 32:1040-1065. [PMID: 36400477 DOI: 10.1016/j.purol.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The objective of this publication is to recall the initial work-up when faced with an adrenal incidentaloma and, if necessary, to establish the oncological management of an adrenal malignant tumor. MATERIAL AND METHODS The multidisciplinary working group updated French urological guidelines about oncological assessment of the adrenal incidentaloma, established by the CCAFU in 2020, based on an exhaustive literature review carried out on PubMed. RESULTS Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by adrenocortical carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical/hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis, which will make it possible to close the malignancy assessment and make the oncological diagnosis. CONCLUSIONS ACC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE - adrenal cancer network (Appendix 1).
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Pisarska-Adamczyk M, Zawadzka K, Więckowski K, Przęczek K, Major P, Wysocki M, Małczak P, Pędziwiatr M. Risk factors for hemodynamic instability during laparoscopic pheochromocytoma resection: a retrospective cohort study. Gland Surg 2021; 10:892-900. [PMID: 33842234 DOI: 10.21037/gs-20-783] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Adrenalectomy for pheochromocytoma, a rare catecholamine-secreting tumour, is a challenging procedure because of the high risk of intraoperative hemodynamic instability, which can cause life-threatening complications. Our study aimed to identify predictive factors for hemodynamic instability during pheochromocytoma resection as well as to assess the risk factors for postoperative morbidity. Methods Data of 96 patients, who underwent laparoscopic adrenalectomy were analysed retrospectively. Hemodynamic instability was defined as an occurrence of both intraoperative episodes of systolic blood pressure above 160 mmHg and vasoactive (vasodilators or vasoconstrictors) drug administration. Patients were divided into two groups: one which met both criteria, and another one without hemodynamic instability-42 (43.8%) and 54 (56.2%) respectively. Results The mean tumour size was 4.5±2.0 cm. 86 patients had a sporadic pheochromocytoma and 10 (10.4%) had a familial disease. Sixty-three patients were preoperatively treated with nonselective blockers and 33 patients with selective blockers. Mean operative time was 98.7±41.7 min. and mean intraoperative blood loss was 165.7±381.2 mL. In 26% of patients, postoperative complications occurred. The median length of hospital stay was 3 days. The multivariate logistic regression model showed that the size of adrenal tumour and diabetes were significant factors of hemodynamic instability. Intraoperative use of vasopressors was an independent risk factor for both all-cause and cardiovascular morbidity. Conclusions Adrenal tumour size and diabetes were associated with hemodynamic instability during pheochromocytoma resection. The only risk factor for complications in our group was intraoperative necessity to use vasopressors.
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Affiliation(s)
- Magdalena Pisarska-Adamczyk
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Karolina Zawadzka
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Więckowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Przęczek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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Rodríguez-Hermosa JI, Delisau O, Planellas-Giné P, Cornejo L, Ranea A, Maldonado E, Fernández-Real JM, Codina-Cazador A. Factors associated with prolonged hospital stay after laparoscopic adrenalectomy. Updates Surg 2020; 73:693-702. [PMID: 32940830 DOI: 10.1007/s13304-020-00880-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Laparoscopy is the standard technique for resecting adrenal tumors, but short-term outcomes such as length of stay (LOS) vary widely between centers. We aimed to identify factors associated with LOS after lateral transperitoneal laparoscopic adrenalectomy (LTLA). We analyzed consecutive patients undergoing unilateral LTLA between April 2003 and April 2020. Prolonged LOS was defined as a stay longer than the 75th percentile of the overall cohort. To identify potential factors associated with prolonged LOS, we compared collected data from patients with LOS ≤ 2 days versus LOS > 2 days and elaborated multivariate logistic regression models. We included 150 patients (73 men and 77 women, median age 54 years), with benign (n = 128) and malignant tumors (n = 22). The median LOS after LTLA was 2 days; 64 (42.7%) patients had prolonged hospitalization. Variables significantly associated with prolonged LOS in the univariate analysis included ASA III + IV (p = 0.016), pheochromocytoma (p < 0.001), learning curve (p = 0.032), surgery on Thursday or Friday (p < 0.001), 2D laparoscopy (p = 0.003), operative time (p < 0.001), estimated blood loss (p < 0.001), drainage (p < 0.001), specimen size (p = 0.011), conversions (p = 0.002), complications (p = 0.019), and hospital stay (p < 0.001). After adjustment for patient, surgical, and tumor characteristics, risk factors associated with prolonged LOS in the multivariate analysis were specimen size > 9 cm (OR:13.03, p = 0.005), surgery on Thursday or Friday (OR:6.92, p = 0.001), estimated blood loss ≥ 60 ml (OR:6.22, p = 0.021), and drainage (OR:5.29, p = 0.005). Prolonged length of stay after LTLA was associated with specimen size > 9 cm, operating on Thursday or Friday, estimated blood loss ≥ 60 mL, and drainage.
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Affiliation(s)
- José Ignacio Rodríguez-Hermosa
- Endocrine Surgery Unit, Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Avda. França, s/n, 17007, Girona, Spain.
| | - Olga Delisau
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Pere Planellas-Giné
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Lídia Cornejo
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Alejandro Ranea
- Endocrine Surgery Unit, Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Avda. França, s/n, 17007, Girona, Spain
| | - Eloy Maldonado
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - José Manuel Fernández-Real
- Department of Endocrinology, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Antoni Codina-Cazador
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
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Berends AMA, Kerstens MN, Lenders JWM, Timmers HJLM. Approach to the Patient: Perioperative Management of the Patient with Pheochromocytoma or Sympathetic Paraganglioma. J Clin Endocrinol Metab 2020; 105:5868468. [PMID: 32726444 DOI: 10.1210/clinem/dgaa441] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/06/2020] [Indexed: 02/04/2023]
Abstract
Pheochromocytomas and sympathetic paraganglioma (PPGL) are rare chromaffin cell tumors originating in the adrenal medulla and sympathetic paraganglia, respectively, which share the capacity to synthesize and release catecholamines. The incidence of PPGL has increased in recent years. Surgical resection is the only curative treatment for PPGL. Management of patients with PPGL is complex and should be done by a specialized multidisciplinary team in centers with broad expertise. Surgical resection of a PPGL is a high-risk procedure for which optimal pretreatment with antihypertensive drugs is required in combination with state-of-the-art surgical procedures and anesthesiological techniques. In this article we discuss the underlying evidence and the pros and cons of presurgical medical preparation. Finally, the areas of uncertainty and controversies in this field are addressed.
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Affiliation(s)
- Annika M A Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Ma L, Shen L, Zhang X, Huang Y. Predictors of hemodynamic instability in patients with pheochromocytoma and paraganglioma. J Surg Oncol 2020; 122:803-808. [PMID: 32562589 PMCID: PMC7496938 DOI: 10.1002/jso.26079] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Intraoperative hemodynamic instability is common in patients with pheochromocytoma and paraganglioma. The aim of this study was to identify the predictive risk factors of intraoperative hemodynamic instability. METHODS A total of 428 patients having elective resection of pheochromocytoma and/or paraganglioma at Peking Union Medical College Hospital between January 2014 and July 2019 were included. The association between preoperative parameters and the incidence of intraoperative hemodynamic instability were evaluated. Binary logistic regression was used to assess the predictive risk factors of hemodynamic instability. RESULTS Patients with intraoperative hemodynamic instability were more prone to have elevated levels of norepinephrine and epinephrine. Binary Logistic regression showed the risk factors of hemodynamic instability were tumor size >5.0 cm (odds ratio [OR], 1.889; 95% confidence interval [CI], 1.243-2.870; P = .003) and five-fold increases of urine epinephrine (OR, 2.195; 95% CI, 1.242-3.880; P = .007). CONCLUSIONS Intraoperative hemodynamic instability is common despite adequate preoperative medical treatment. Tumor size and high level of urinary epinephrine are tumor-related factors for intraoperative hemodynamic instability. Identifying these factors can help clinicians to manage patients more effectively and improve patients' outcomes.
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Affiliation(s)
- Lulu Ma
- Department of AnesthesiologyPeking Union Medical College HospitalBeijingChina
| | - Le Shen
- Department of AnesthesiologyPeking Union Medical College HospitalBeijingChina
| | - Xiuhua Zhang
- Department of AnesthesiologyPeking Union Medical College HospitalBeijingChina
| | - Yuguang Huang
- Department of AnesthesiologyPeking Union Medical College HospitalBeijingChina
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Pheochromocytoma surgery without systematic preoperative pharmacological preparation: insights from a referral tertiary center experience. Surg Endosc 2020; 35:728-735. [DOI: 10.1007/s00464-020-07439-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
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