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Corallino D, Balla A, Palmieri L, Sperduti I, Ortenzi M, Guerrieri M, Paganini AM. Is transperitoneal laparoscopic adrenalectomy for pheochromocytoma really more challenging? A propensity score-matched analysis. J Endocrinol Invest 2023:10.1007/s40618-023-02013-7. [PMID: 36705839 DOI: 10.1007/s40618-023-02013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Minimally invasive surgery is the gold standard treatment for adrenal masses, but it may be a challenging procedure in the case of pheochromocytoma (PHEO). The aim of the present study is to report the results of transperitoneal laparoscopic adrenalectomy (TLA) in cases of PHEO in comparison to other types of adrenal lesions. METHODS From 1994 to 2021, 629 patients underwent adrenalectomy. Twenty-two and thirty-five patients, respectively, were excluded because they underwent bilateral and open adrenalectomy, leaving 572 patients for inclusion. Of these, 114 patients had PHEO (Group A), and 458 had other types of lesions (Group B). To adjust for potential baseline confounders, a propensity score matching (PSM) analysis was conducted. RESULTS After PSM, 114 matched pairs of patients were identified from each group. Statistically significant differences were not observed when comparing the median operative time (85 and 90 min in Groups A and B, respectively, p = 0.627), conversion rate [6 (5.3%) in each group, p = 1.000], transfusion rate [4 (3.5%) and 3 (2.6%) in Groups A and B, respectively, p = 1.000], complication rate [7 (6.1%) and 9 (7.9%) in Groups A and B, respectively, p = 0.796), median postoperative hospital stay (3.9 and 3.6 days in Groups A and B, respectively, p = 0.110), and mortality rate [1 (0.9%) in each group, p = 1.000]. CONCLUSIONS Based on this analysis, the results of TLA for PHEO are equivalent to those of TLA for other types of adrenal lesions, but the fundamental requirements are multidisciplinary patient management and adequate surgeon experience. Further prospective studies are required to draw definitive conclusions.
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Affiliation(s)
- D Corallino
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - A Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Civitavecchia, Rome, Italy
| | - L Palmieri
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - I Sperduti
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - M Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - A M Paganini
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Baio R, Pagano T, Molisso G, Di Mauro U, Intilla O, Albano F, Scarpato F, Giacometti S, Sanseverino R. When a Multidisciplinary Approach Is Life-Saving: A Case Report of Cardiogenic Shock Induced by a Large Pheochromocytoma. Diseases 2022; 10:29. [PMID: 35645250 PMCID: PMC9149903 DOI: 10.3390/diseases10020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pheochromocytoma is known for its instantaneous presentation, especially in the younger population. Hemodynamic instability may be the cause of severe complications and impede patients' ability to undergo surgical treatment. These tumours are surgically difficult to treat due to the risk of catecholamine release during their manipulations, and when they are large, the tumour size represents an additional challenge. In our report, cardiogenic shock developed due to increases in systemic vascular resistance, and the lesion's size induced surgeons to perform open surgery. CASE PRESENTATION A 46-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Systolic dysfunction was noted, along with severely increased systemic vascular resistance. A CT scan showed a left-sided 8.5 cm adrenal mass, which was confirmed as pheochromocytoma using meta-iodobenzylguanidine scintigraphy. Anaesthesiologists and the surgical team planned an effective strategy of treatment. Given the lesion's size and its apparent invasion of the neighbouring organs, open adrenalectomy (after prolonged hemodynamic stabilisation) was considered safer. The surgery was successful, and the patient remains free from disease two years after the initial event. CONCLUSIONS Large pheochromocytoma can be safely and effectively treated with open surgery by experienced hands but only by seeking to reach hemodynamic stabilisation and minimising the release of catecholamine before and during surgery.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, I-84081 Salerno, Italy
| | - Tommaso Pagano
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Giovanni Molisso
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Umberto Di Mauro
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Olivier Intilla
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Francesco Albano
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Fulvio Scarpato
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Stefania Giacometti
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
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Guo Y, Li H, Xie D, You L, Yan L, Li Y, Zhang S. Hemorrhage in pheochromocytoma surgery: evaluation of preoperative risk factors. Endocrine 2022; 76:426-433. [PMID: 35426588 PMCID: PMC9068676 DOI: 10.1007/s12020-021-02964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pheochromocytoma surgery carries a higher risk of hemorrhage. Our objective was to identify preoperative risk factors for hemorrhage during pheochromocytoma surgery. METHODS Patients who underwent surgery and with postoperative pathological confirmation were enrolled. A total of 251 patients from our center were included in the investigation, and 120 patients from the First Affiliated Hospital, Sun Yat-sen University were included as an external validation dataset. Family and medical history, demographics, hemodynamics, biochemical parameters, image data, anesthesia and operation records, postoperative outcomes were collected. Postoperative complications were graded by the Clavien-Dindo classification. Correlation between intraoperative hemorrhage volume and postoperative outcomes was assessed. The features associated with intraoperative hemorrhage were identified by linear regression. All features that were statistically significant in the multiple linear regression were then used to construct models and nomograms for predicting intraoperative hemorrhage. The constructed models were evaluated by Akaike Information Criterion. Finally, internal and external validations were carried out by tenfold cross-validation. RESULTS Intraoperative hemorrhage volume was positively correlated with the postoperative hospitalization time (R = 0.454, P < 0.001) and the Clavien-Dindo grades (R = 0.664, P < 0.001). Features associated with intraoperative hemorrhage were male gender (β = 0.533, OR = 1.722, P = 0.002), tumor diameter (β = 0.027, OR = 1.027, P < 0.001), preoperative CCB use (β = 0.318, OR = 1.308, P = 0.123) and open surgery (β = 1.175, OR = 3.234, P < 0.001). Validations showed reliable results (internal (R = 0.612, RMSE = 1.355, MAE = 1.111); external (R = 0.585, RMSE = 1.398, MAE = 0.964)). CONCLUSION More intraoperative hemorrhage is correlated with longer postoperative hospitalization time and more severe postoperative complications. Male gender, larger tumor, preoperative CCB use and open surgery are preoperative risk factors for hemorrhage in PCC surgery.
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Affiliation(s)
- Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dingxiang Xie
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Duralska M, Dzwonkowski J, Sierdziński J, Nazarewski S. A Retrospective Study of 881 Lateral Transabdominal Laparoscopic Adrenalectomies Performed Between 1997 and 2017 at a Single Center in Poland to Determine Factors Associated with Surgery Time. Med Sci Monit 2022; 28:e936272. [PMID: 35361745 PMCID: PMC8982100 DOI: 10.12659/msm.936272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy is acknowledged as a standard procedure in adrenal lesions management. This retrospective study of lateral transabdominal laparoscopic adrenalectomy performed between 1997 and 2017 in a single center in Poland aimed to determine the factors associated with surgery time. MATERIAL AND METHODS This retrospective study involved 881 patients. The factors identified as potentially affecting surgery time were age, sex, side of the lesion, histopathological type, hormonal activity, size of the lesion, history of previous abdominal operations, presence of intra-abdominal adhesions, and obesity. The following statistical tests were conducted: t test, Mann-Whitney U test, Kruskal-Wallis H test, Pearson correlation test, and multivariate regression modeling. RESULTS The mean surgery time for all operations was 139 min (55-320 min). We observed statistically significant differences for surgery time in the following groups: sex, side of the lesion, presence of intra-abdominal adhesions, obesity, histopathological type, and hormonal activity (P<0.05). The multivariate regression model showed factors affecting surgery time were: sex, side of the lesion, size of the lesion, obesity, histopathological type (nodular hyperplasia and adenoma), and hormonal activity (non-functioning and aldosterone-secreting tumors) (P<0.05). There was no correlation between surgery time and patient age and tumor size (P<0.05). Mean tumor size was 42 mm (6-130 mm). CONCLUSIONS The 20-year experience of laparoscopic adrenalectomy performed at a single center showed that surgery duration was significantly longer in male patients, obese patients, left-sided adrenal tumors, tumors >6 cm in diameter, patients with a diagnosis of pheochromocytoma, and when intra-abdominal adhesions were present.
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Affiliation(s)
- Milena Duralska
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Dzwonkowski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Nazarewski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
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Zhao Y, Fang L, Cui L, Bai S. Application of data mining for predicting hemodynamics instability during pheochromocytoma surgery. BMC Med Inform Decis Mak 2020; 20:165. [PMID: 32690077 PMCID: PMC7370474 DOI: 10.1186/s12911-020-01180-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/07/2020] [Indexed: 01/29/2023] Open
Abstract
Background Surgical resection of pheochromocytoma may lead to high risk factors for intraoperative hemodynamic instability (IHD), which can be life-threatening. This study aimed to investigate the risk factors that could predict IHD during pheochromocytoma surgery by data mining. Method Relief-F was used to select the most important features. The accuracies of seven data mining models (CART, C4.5, C5.0, and C5.0 boosted), random forest algorithm, Naive Bayes and logistic regression were compared, the cross-validation, hold-out, and bootstrap methods were used in the validation phase. The accuracy of these models was calculated independently by dividing the training and the test sets. Receiver-Operating Characteristic curves were used to obtain the area under curve (AUC). Result Random forest had the highest AUC and accuracy values of 0.8636 and 0.8509, respectively. Then, we improved the random forest algorithm according to the classification of imbalanced data. Improved random forest model had the highest specificity and precision among all algorithms, including relatively higher sensitivity (recall) and the highest f1-score integrating recall and precision. The important attributes were body mass index, mean age, 24 h urine vanillylmandelic acid/upper normal limit value, tumor size and enhanced computed tomography difference. Conclusions The improved random forest algorithm may be useful in predicting IHD risk factors in pheochromocytoma surgery. Data mining technologies are being increasingly applied in clinical and medical decision-making, and provide continually expanding support for the diagnosis, treatment, and prevention of various diseases.
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Affiliation(s)
- Yueyang Zhao
- Library of Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Li Fang
- Library of Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Lei Cui
- Department of Information Management and Information System (Medicine), China Medical University, Shenyang, 110001, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
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Large Adrenal Lesion Series in a Tertiary Care Center in Northern India: Diagnostic and Operative Challenges. Indian J Surg Oncol 2020; 11:518-526. [PMID: 33013138 DOI: 10.1007/s13193-020-01114-6] [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: 12/11/2018] [Accepted: 05/30/2020] [Indexed: 10/24/2022] Open
Abstract
Large adrenal tumors pose varied challenges to surgeons in terms of diagnosis, planning surgical approach, and also intra-operative difficulties in resection. The aim of this study is to discuss challenges in the management of large and difficult adrenal lesions. A retrospective analysis was done on data of all patients with large adrenal lesions/paragangliomas managed from 1 June 2016 to 30 August 2018. Forty-eight patients with adrenal lesions underwent treatment in 2 years duration. Pain in the abdomen was the most common presentation. Mean age was 34.4 years (range 2-60), female to male (23:25) and right to left side to bilateral tumor 30:16:2. Thirty-one (64.6%) patients had large adrenal masses (size > 6 cm). Surgical approaches included open transperitoneal adrenalectomy (n = 20) and laparoscopic transperitoneal (n = 9 and 2 others had conversion to open procedure). Challenges faced are described in the table below: [Table: see text] There were no major peri-operative morbidities, but two patients died in perioperative period. Large adrenal tumors pose a challenge in surgical planning, approach, and resection and need careful planning and multidisciplinary team approach to have the best outcomes.
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7
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Wang H, Wu B, Yao Z, Zhu X, Jiang Y, Bai S. Nomogram for predicting severe morbidity after pheochromocytoma surgery. Endocr Connect 2020; 9:309-317. [PMID: 32182582 PMCID: PMC7159264 DOI: 10.1530/ec-20-0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Although resection is the primary treatment strategy for pheochromocytoma, surgery is associated with a high risk of morbidity. At present, there is no nomogram for prediction of severe morbidity after pheochromocytoma surgery, thus the aim of the present study was to develop and validate a nomogram for prediction of severe morbidity after pheochromocytoma surgery. METHODS The development cohort consisted of 262 patients who underwent unilateral laparoscopic or open pheochromocytoma surgery at our center between 1 January 2007 and 31 December 2016. The patients' clinicopathological characters were recorded. The least absolute shrinkage and selection operator (LASSO) binary logistic regression model was used for data dimension reduction and feature selection, then multivariable logistic regression analysis was used to develop the predictive model. An independent validation cohort consisted of 128 consecutive patients from 1 January 2017 and 31 December 2018. The performance of the predictive model was assessed in regards to discrimination, calibration, and clinical usefulness. RESULTS Predictors of this model included sex, BMI, coronary heart disease, arrhythmia, tumor size, intraoperative hemodynamic instability, and surgical duration. For the validation cohort, the model showed good discrimination with an AUROC of 0.818 (95% CI, 0.745, 0.891) and good calibration (Unreliability test, P = 0.440). Decision curve analysis demonstrated that the model was also clinically useful. CONCLUSIONS A nomogram was developed to facilitate the individualized prediction of severe morbidity after pheochromocytoma surgery and may help to improve the perioperative strategy and treatment outcome.
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Affiliation(s)
- Hongyan Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunzhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence should be addressed to S Bai:
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Legocka ME, Toutounchi S, Pogorzelski R, Krajewska E, Celejewski K, Galazka Z. Undiagnosed Pheochromocytoma Presenting as a Pancreatic Tumor: A Case Report. Open Med (Wars) 2020; 15:103-106. [PMID: 32161778 PMCID: PMC7053398 DOI: 10.1515/med-2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/06/2019] [Indexed: 12/31/2022] Open
Abstract
Pheochromocytoma is a rare catecholamine-producing tumor of the adrenal gland. Patients with known pheochromocytoma undergoing surgery require preoperative treatment with alpha-blockers to reduce the risk of intraoperative complications related to catecholamine release. If undiagnosed, pheochromocytoma can lead to life-threatening surgical complications. We report the case of a patient with a suspected solid pseudopapillary neoplasm in the pancreatic tail, for whom pancreatoduodenectomy was scheduled. However, shortly after abdominal incision, hypertensive crisis developed and was followed by severe hypotension requiring intravenous vasopressors, which prompted discontinuation of the operation. Further diagnostic evaluation revealed marked elevations in urinary excretion of methylated catecholamines and suggested that the tumor was in fact a pheochromocytoma extending from the left adrenal gland. After preoperative treatment with doxazosin, the patient underwent lateral transperitoneal laparoscopic adrenalectomy, with no major complications and an uneventful postoperative course. The pathological report confirmed a diagnosis of pheochromocytoma. Due to the potential for life-threatening surgical complications in patients with pheochromocytoma not treated preoperatively with alpha-blockers, this tumor type should be included in the differential diagnosis of abdominal tumors of unknown origin.
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Affiliation(s)
- Malgorzata Emilia Legocka
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | | | - Ryszard Pogorzelski
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | - Ewa Krajewska
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | - Krzysztof Celejewski
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | - Zbigniew Galazka
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
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Maestroni U, Ziglioli F, Baciarello M, Bellini V, Dalla Valle R, Cataldo S, Maspero G, Bignami E. Multidisciplinary management of a large pheochromocytoma presenting with cardiogenic shock: a case report. BMC Urol 2019; 19:118. [PMID: 31747934 PMCID: PMC6868789 DOI: 10.1186/s12894-019-0554-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 11/08/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pheochromocytoma is well-known for sudden initial presentations, particularly in younger patients. Hemodynamic instability may cause serious complications and delay a patient's ability to undergo surgical resection. Larger tumors present a further challenge because of the risk of catecholamine release during manipulations. In the case we present, increases in systemic vascular resistance caused cardiogenic shock, and the size of the lesion prompted surgeons to veer off from their usual approach. CASE PRESENTATION A 38-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Profound systolic dysfunction (left ventricular ejection fraction of 0.12) was noted together with severely increased systemic vascular resistance, and gradually responded to vasodilator infusion. A left-sided 11-cm adrenal mass was found with computed tomography and confirmed a pheochromocytoma with a meta-iodo-benzyl-guanidine scintigraphy. Surgical treatment was carefully planned by the endocrinologist, anesthesiologist and surgeon, and was ultimately successful. After prolonged hemodynamic stabilization, open adrenalectomy and nephrectomy were deemed safer because of lesion size and the apparent invasion of the kidney. Surgery was successful and the patient was discharged home 5 days after surgery. She is free from disease at almost 2 years from the initial event. CONCLUSIONS Large, invasive pheochromocytoma can be safely and effectively managed with open resection in experienced hands, provided all efforts are made to achieve hemodynamic stabilization and to minimize. Catecholamine release before and during surgery.
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Affiliation(s)
- Umberto Maestroni
- Department. of General and Specialty Surgery, Urology Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Ziglioli
- Department. of General and Specialty Surgery, Urology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Baciarello
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy.
| | - Valentina Bellini
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
| | - Raffaele Dalla Valle
- Department of Medicine and Surgery, Hepatobiliary Surgery Unit, University of Parma, Parma, Italy
| | - Simona Cataldo
- Department of Medicine, Endocrinology and Metabolic Diseases Unit, University Hospital of Parma, Parma, Italy
| | - Giada Maspero
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
| | - Elena Bignami
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
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Dworak J, Wysocki M, Rzepa A, Natkaniec M, Pędziwiatr M, Budzyński A, Major P. Laparoscopic adrenalectomy - is it safe in hands of residents in training? BMC Urol 2019; 19:102. [PMID: 31660932 PMCID: PMC6816204 DOI: 10.1186/s12894-019-0538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/10/2019] [Indexed: 01/10/2023] Open
Abstract
Background Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery. Methods A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”. Results We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741). Conclusions Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.
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Affiliation(s)
- Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Anna Rzepa
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.
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Gunseren KO, Cicek MC, Vuruskan H, Kordan Y, Yavascaoglu I. Challenging risk factors for right and left laparoscopic adrenalectomy: A single centre experience with 272 cases. Int Braz J Urol 2019; 45:747-753. [PMID: 31136115 PMCID: PMC6837586 DOI: 10.1590/s1677-5538.ibju.2019.0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 03/20/2023] Open
Abstract
Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient’s medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.
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Affiliation(s)
- Kadir Omur Gunseren
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
| | - Mehmet Cagatay Cicek
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
| | - Yakup Kordan
- Departmet of Urology, Koc University, School of Medicine, Nilufer, Bursa, Turkey
| | - Ismet Yavascaoglu
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
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Liu H, Li B, Yu X, Huang Y. Perioperative management during laparoscopic resection of large pheochromocytomas: A single-institution retrospective study. J Surg Oncol 2018; 118:709-715. [PMID: 30175399 DOI: 10.1002/jso.25205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/22/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The safety of laparoscopic resection of very large pheochromocytomas is unclear, and preoperative preparation may benefit from refinement. This retrospective study was designed to determine the correlation between tumor size and perioperative characteristics by evaluating data from patients who underwent laparoscopic resection of pheochromocytomas. METHODS A total of 253 patients were grouped according to their tumor diameter: diameter ≥8 cm, Glarge (Glg ) (n = 30); diameter 6 to 8 cm, Gmedium (Gmd ) (n = 57); and diameter <6 cm, Gsmall (Gsm ) (n = 166). The perioperative data were compared among the three groups using the analysis of variance test, Wilcoxon's rank-sum test, and the chi-square test. RESULTS Patients in the Glg and Gmd groups had a higher preoperative phenoxybenzamine daily dose and 24-hour urine levels of noradrenaline and adrenaline than those in the Gsm group, as they needed longer vasopressor support. Transfusion of allogeneic blood products was found to be increased in patients of the Glg group compared with the other two groups and their intensive care unit stays were longer. CONCLUSIONS Compared with small-sized pheochromocytomas, laparoscopic resection of medium-sized pheochromocytomas requires vigilant monitoring and resolution of hemodynamic fluctuations. Patients with very large pheochromocytomas are at greater risk of intraoperative bleeding and may benefit from the ensured availability of blood products and intensive postoperative monitoring.
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Affiliation(s)
- Hongju Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Bin Li
- Department of Anesthesiology, Jiujiang Maternal and Child Care Centres, Jiangxi, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
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Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome. Wideochir Inne Tech Maloinwazyjne 2018; 13:292-298. [PMID: 30302141 PMCID: PMC6174161 DOI: 10.5114/wiitm.2018.74833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/02/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The primary treatment of Conn’s syndrome (CS) is laparoscopic adrenalectomy and aims to normalize arterial blood pressure and biochemical parameters. Aim To analyse short- and long-term results of laparoscopic adrenalectomy for Conn’s syndrome (CS). Material and methods The analysis included 44 consecutive patients, who underwent laparoscopic adrenalectomy between 2004 and 2015 for CS. We analysed short- and long-terms results of operations. All patients were followed up 6 and 24 months after surgery to determine changes in the biochemical parameters, and clinical regression of arterial hypertension. We also evaluated the aldosteronoma resolution score (ARS) in predicting the resolution of hypertension. Results No conversions were needed. Complications occurred in 5 (11.4%) patients. Preoperative hypokalaemia and hypernatraemia were present in 83.4% and 15.8% of patients, respectively. After surgery, both hypokalaemia and hypernatraemia resolved in all patients. At the follow-up 6 months after the surgery, only 11.3% of patients had complete remission (CR) of hypertension. In 43.2% of cases we observed partial remission (PR). After 24 months CR was found in 13.6% of patients, 45.5% patients fulfilled criteria for PR, and 29.5% of patients changed the group of remission comparison to the first follow-up visit. Only 50% of patients with an ARS of 4 or 5 points achieved CR 6 months after surgery. Conclusions Laparoscopic adrenalectomy is a safe method of treatment for CS. Although it effectively eliminates electrolyte imbalance, it does not allow for the CR of hypertension in the majority of patients, especially in the elderly group. We did not find ARS to be an effective tool in predicting postoperative resolution of hypertension.
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Chung HS, Kim MS, Yu HS, Hwang EC, Kim SO, Oh KJ, Jung SI, Kang TW, Park K, Kwon DD. Laparoscopic adrenalectomy using the lateral retroperitoneal approach: Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm? Int J Urol 2018; 25:414-419. [PMID: 29478297 DOI: 10.1111/iju.13524] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/07/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the surgical feasibility of laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of large pheochromocytomas, and to identify the preoperative risk factors for intraoperative hypertension. METHODS We retrospectively reviewed 51 patients who underwent laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of pheochromocytomas. Patient characteristics and perioperative outcomes were analyzed and compared between the two study groups based on tumor size: group A (n = 27, ≤6 cm) and group B (n = 24, ˃6 cm). RESULTS There was no significant difference in preoperative characteristics between the two groups except for tumor size (P = 0.001) and urinary metanephrine (P = 0.011). Group B patients required longer operating time (P = 0.008), had a greater estimated blood loss (P = 0.001) and hemoglobin change (P = 0.002). However, no significant differences were observed in perioperative complications and mortality. Multivariate analysis showed that symptomatic pheochromocytomas (P = 0.004) and tumor size (P = 0.007) were significant risk factors for intraoperative hypertension. CONCLUSIONS Laparoscopic adrenalectomy using the lateral retroperitoneal approach for pheochromocytomas can be regarded as a treatment option, even for tumors measuring >6 cm. Symptomatic pheochromocytomas and large tumor size seem to represent risk factors for intraoperative hypertension.
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Affiliation(s)
- Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Soo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Risk factors for prolonged hospitalization in patients undergoing laparoscopic adrenalectomy. Wideochir Inne Tech Maloinwazyjne 2018; 13:141-147. [PMID: 30002745 PMCID: PMC6041577 DOI: 10.5114/wiitm.2018.73357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/03/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction Even though laparoscopic adrenalectomy is currently a standard, there are important variations between different centres in short-term treatment results such as length of hospital stay (LOS) or morbidity. Aim To determine the factors affecting LOS in patients after laparoscopic transperitoneal lateral adrenalectomy (LTA). Material and methods The study enrolled 453 patients (173 men and 280 women, mean age 57 years) who underwent LTA between 2009 and 2017. Discharge from hospital after more than median hospital stay was considered as prolonged LOS. We evaluated factors that potentially may influence LOS (primary length of stay after surgery, excluding readmissions). Logistic regression models were used in univariate and corrected multivariate analyses, in order to identify the factors related to prolonged LOS. Results The median LOS after LTA in the studied group was 2 days. One hundred seventy-five (38.5%) patients required prolonged hospitalization. Univariate logistic regression showed that the following factors were related to prolonged LOS: presence of any comorbidity, cardiovascular disease, intraoperative complications, postoperative complications, day of the week of operation (surgery on Thursday or Friday), intraoperative blood loss, need for transfusion, hormonal activity, postoperative drainage, ASA (III–IV) and histological type – pheochromocytoma. Multivariate logistic regression showed that only complications (OR = 3.86; 95% CI: 1.84–8.04), day of the week of operation (Thursday or Friday) (OR = 4.85; 95% CI: 3.04–7.73), need for drainage (OR = 3.63; 95% CI: 1.55–8.52), and histological type – pheochromocytoma (OR = 2.48; 95% CI: 1.35–4.54) prolonged LOS. Conclusions Prolonged length of hospital stay following laparoscopic transperitoneal lateral adrenalectomy is strongly associated with the presence of postoperative complications, day of the week of operation (Thursday or Friday), need for drainage, and histological type – pheochromocytoma.
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Preoperative risk factors for massive blood loss in adrenalectomy for pheochromocytoma. Oncotarget 2017; 8:79964-79970. [PMID: 29108378 PMCID: PMC5668111 DOI: 10.18632/oncotarget.20396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022] Open
Abstract
Background This retrospective analysis of patients who underwent adrenalectomy for pheochromocytoma aimed to determine preoperative risk factors for intraoperative massive blood loss. Preoperative identification of patients at high-risk of massive blood loss may be helpful in anesthesia management and preoperative preparation. Materials and Methods The study involved data of 268 patients who had undergone pheochromocytoma surgery at the Peking Union Medical College Hospital between January 1, 2013 and October 31, 2016. For analysis, the patients were grouped according to intraoperative blood loss: ≥ 20% of estimated blood volume (group A, n = 38) and < 20% of estimated blood volume (group B, n = 230). Perioperative characteristics were compared between the two groups. Significant variables were selected for a forward stepwise binary logistic regression analysis to determine the independent risk factors for massive blood loss. Results The two groups showed significant differences in tumor location, tumor size, operative approach, preoperative 24-hour urine level of total noradrenaline, preoperative hemoglobin concentration, phenoxybenzamine maximum daily dose, preoperative preparation time, intraoperative urine volume, crystalloid and colloidal fluid volumes, allogeneic red blood cell transfusion, plasma and autologous blood transfusion volumes, incidence of prolonged hypotension, postoperative drainage volume, lowest and discharge hemoglobin concentrations, length of stay in intensive care unit and length of postoperative hospitalization. Binary logistic regression analysis indicated increased risk of intraoperative massive blood loss in subjects with tumors proximal to vessels or other organs (odds ratio (OR): 4.227), with tumors ≥ 5 cm (OR: 7.321), or with preoperative preparation time of ≤ 14 days (OR: 17.747). Conclusions Tumors proximal to vessels and other organs or with maximum diameter of ≥ 5 cm (as shown by preoperative radiographic evidence), and preoperative preparation time of ≤ 14 days were independent risk factors of intraoperative massive blood loss in patients treated with adrenalectomy for pheochromocytoma.
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Natkaniec M, Dworak J, Pędziwiatr M, Pisarska M, Major P, Dembiński M, Winiarski M, Budzyński A. Patients criteria determining difficulty of the laparoscopic lateral transperitoneal adrenalectomy. A retrospective cohort study. Int J Surg 2017; 43:33-37. [PMID: 28528215 DOI: 10.1016/j.ijsu.2017.05.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identification of patients in whom adrenalectomy may be more difficult, can help in decision making in borderline and doubtful cases. The aim of the study was to determine patients criteria influencing difficulty of laparoscopic lateral transperitoneal adrenalectomy (LTA). MATERIAL AND METHODS The study enrolled 275 patients who underwent LTA. We analyzed the impact of gender, age, history of previous abdominal surgery, body mass index, risk of anesthesia measured as ASA scale, size, localization (left/right), and histological type of the tumor on parameters reflecting the level of difficulty of the procedure: operative time, intraoperative blood loss, conversion rate and intraoperative complications rate. RESULTS Multivariate logistic regression showed that following factors were associated with longer operative time: gender, tumor size and malignant lesions. In another model it was shown that age, size of the tumor and malignancy were associated with more excessive blood loss. Moreover, it was shown, that tumor size predictive factor for conversion. Univariate analysis showed a relation with malignancy, but multivariate analysis revealed no significance. CONCLUSIONS Patient age, gender, size and histological type of the tumor are criteria influencing parameters reflecting the level of difficulty. This criteria could be considered as predictors of the difficulty of LTA. Surgery in case of patients with combination of this risk factors should be handled by surgeon with sufficient experience to minimalize the risk of adverse events.
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Affiliation(s)
- Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland.
| | - Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
| | - Marcin Dembiński
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
| | - Marek Winiarski
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University, Kraków, Poland
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Laparoscopic left and right adrenalectomy from an anterior approach - is there any difference? Outcomes in 176 consecutive patients. Wideochir Inne Tech Maloinwazyjne 2016; 11:268-273. [PMID: 28194247 PMCID: PMC5299086 DOI: 10.5114/wiitm.2016.64767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 01/23/2023] Open
Abstract
Introduction Traditionally, in open surgery, right adrenalectomy is considered technically more demanding than its left-sided counterpart. This belief is supposed to be attributable mainly to different anatomic characteristics of the adrenal veins. Whether this opinion is also correct for laparoscopic adrenalectomy remains elusive. Aim To compare the outcomes of left versus right laparoscopic adrenalectomy from an anterior approach. Material and methods Retrospective statistical analysis of a prospectively compiled database of consecutive patients undergoing laparoscopic adrenalectomy in a single center with focus on potential differences in the left- versus right-sided procedure in terms of demographic parameters, tumor size, operating time, occurrence of serious intraoperative complications, conversion, length of hospital stay and re-operation rate. Results One hundred seventy-six patients underwent elective laparoscopic adrenalectomy – 80 left-sided (45.45%) and 96 right-sided (54.55%). No significant difference was found between the groups in terms of age (54.09 ±11.2 vs. 56.27 ±11.6; p = 0.2), tumor size (3.39 ±1.86 vs. 3.26 ±1.66; p = 0.64), operating time (71.84 ±22.33 vs. 72.06 ±30.99; p = 0.95), occurrence of serious intraoperative complications (7.5% vs. 10.4%; p = 0.5), conversion (1.25% vs. 1.04%; p = 0.9), length of hospital stay (4.52 ±1.30 vs. 4.37 ±1.91; p = 0.55) or reoperation rate (5% vs. 1%; p = 0.11). There was no mortality. Conclusions No significant difference was found between the left and right laparoscopic adrenalectomy in terms of operating time, occurrence of serious intraoperative complications, conversion rate or postoperative outcome. Therefore, the opinion that the right-sided procedure is more difficult does not seem to be justified for laparoscopic adrenalectomy from the anterior approach.
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Pisarska M, Pędziwiatr M, Budzyński A. Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Gland Surg 2016; 5:506-511. [PMID: 27867865 DOI: 10.21037/gs.2016.09.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Perioperative hemodynamic instability still remains the biggest surgical and anesthetic challenge in surgery for pheochromocytoma. The aim of this review was to discuss pre-, intra- and postoperative factors that may impact on hemodynamic condition of a patient. It describes patients' preparation with appropriate medication, principles of surgical technique as well as risk factors for development of hemodynamic instability in postoperative period. Currently the gold standard in the treatment of pheochromocytoma is preoperative use of alpha-blockers and laparoscopic surgery. This approach allowed improving outcomes by lowering both mortality and morbidity.
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Affiliation(s)
- Magdalena Pisarska
- 2 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland
| | - Andrzej Budzyński
- 2 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland
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