Adrenalectomy for pheochromocytoma: Surgical outcomes and preoperative risk factors for hemodynamic instability

IF 1.8 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology Pub Date : 2024-07-15 DOI:10.1111/iju.15534

Kotaro Suzuki MD, PhD, Yasuyoshi Okamura MD, PhD, Yukari Bando MD, PhD, Takuto Hara MD, PhD, Keisuke Okada MD, PhD, Tomoaki Terakawa MD, PhD, Yoji Hyodo MD, PhD, Koji Chiba MD, PhD, Jun Teishima MD, PhD, Yuzo Nakano MD, PhD, Hideaki Miyake MD, PhD

{"title":"Adrenalectomy for pheochromocytoma: Surgical outcomes and preoperative risk factors for hemodynamic instability","authors":"Kotaro Suzuki MD, PhD, Yasuyoshi Okamura MD, PhD, Yukari Bando MD, PhD, Takuto Hara MD, PhD, Keisuke Okada MD, PhD, Tomoaki Terakawa MD, PhD, Yoji Hyodo MD, PhD, Koji Chiba MD, PhD, Jun Teishima MD, PhD, Yuzo Nakano MD, PhD, Hideaki Miyake MD, PhD","doi":"10.1111/iju.15534","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Background</h3>\n \n <p>Surgical resection for pheochromocytoma (PCC) is still challenging. This study assessed the perioperative outcomes of adrenalectomy for PCC and investigated the risk factors for intraoperative hemodynamic instability (HI).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study included 571 patients with adrenal tumors who underwent adrenalectomy at Kobe University Hospital and other related hospitals between April 2008 and October 2023. The perioperative outcomes of laparoscopic adrenalectomy were compared between PCC (<i>n</i> = 92) and non-PCC (<i>n</i> = 464) groups. In addition, we investigated several potential risk factors for intraoperative HI in patients with PCC (<i>n</i> = 107; open, <i>n</i> = 11; laparoscopic, <i>n</i> = 92; robot-assisted, <i>n</i> = 4).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>While patients with PCC had a significantly larger amount of blood loss in comparison to those with non-PCC (mean, 70 and 30 mL, respectively; <i>p</i> = 0.004), no significant difference was observed in the rate of perioperative grade ≥III complications (1.1% vs. 0.6%; <i>p</i> = 0.516), and no perioperative mortality was observed in either group. A tumor size of ≥40 mm, with preoperative hypertension and urinary metanephrines at a level ≥3 times the upper limit of the normal value, were found to be significant predictors of HI, with odds ratios of 2.74 (<i>p</i> = 0.025), 3.91 (<i>p</i> = 0.005), and 3.83 (<i>p</i> = 0.004), respectively.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our data suggest that laparoscopic adrenalectomy for PCC may be as safe as that for other types of adrenal tumors and that large tumors and hormonally active disease may be risk factors for intraoperative HI. The optimal perioperative management for PCC with these risk factors should be established.</p>\n </section>\n </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"31 10","pages":"1153-1158"},"PeriodicalIF":1.8000,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/iju.15534","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Surgical resection for pheochromocytoma (PCC) is still challenging. This study assessed the perioperative outcomes of adrenalectomy for PCC and investigated the risk factors for intraoperative hemodynamic instability (HI).

Methods

This retrospective study included 571 patients with adrenal tumors who underwent adrenalectomy at Kobe University Hospital and other related hospitals between April 2008 and October 2023. The perioperative outcomes of laparoscopic adrenalectomy were compared between PCC (n = 92) and non-PCC (n = 464) groups. In addition, we investigated several potential risk factors for intraoperative HI in patients with PCC (n = 107; open, n = 11; laparoscopic, n = 92; robot-assisted, n = 4).

Results

While patients with PCC had a significantly larger amount of blood loss in comparison to those with non-PCC (mean, 70 and 30 mL, respectively; p = 0.004), no significant difference was observed in the rate of perioperative grade ≥III complications (1.1% vs. 0.6%; p = 0.516), and no perioperative mortality was observed in either group. A tumor size of ≥40 mm, with preoperative hypertension and urinary metanephrines at a level ≥3 times the upper limit of the normal value, were found to be significant predictors of HI, with odds ratios of 2.74 (p = 0.025), 3.91 (p = 0.005), and 3.83 (p = 0.004), respectively.

Conclusions

Our data suggest that laparoscopic adrenalectomy for PCC may be as safe as that for other types of adrenal tumors and that large tumors and hormonally active disease may be risk factors for intraoperative HI. The optimal perioperative management for PCC with these risk factors should be established.

查看原文本刊更多论文

嗜铬细胞瘤肾上腺切除术：手术效果和术前血流动力学不稳定的风险因素。

背景：嗜铬细胞瘤（PCC）的手术切除仍然具有挑战性。本研究评估了嗜铬细胞瘤肾上腺切除术的围手术期结果，并调查了术中血流动力学不稳定（HI）的风险因素：这项回顾性研究纳入了2008年4月至2023年10月期间在神户大学医院及其他相关医院接受肾上腺切除术的571例肾上腺肿瘤患者。我们比较了PCC组（92人）和非PCC组（464人）腹腔镜肾上腺切除术的围手术期结果。此外，我们还调查了PCC患者（n = 107；开腹，n = 11；腹腔镜，n = 92；机器人辅助，n = 4）术中HI的几个潜在风险因素：虽然PCC患者的失血量明显高于非PCC患者（平均分别为70毫升和30毫升；P = 0.004），但围术期≥III级并发症的发生率无明显差异（1.1% vs. 0.6%；P = 0.516），两组患者均未出现围术期死亡。发现肿瘤大小≥40毫米、术前高血压和尿中甲氧基肾上腺素水平≥正常值上限的3倍是HI的重要预测因素，几率比分别为2.74（p = 0.025）、3.91（p = 0.005）和3.83（p = 0.004）：我们的数据表明，腹腔镜肾上腺切除术治疗PCC可能与治疗其他类型的肾上腺肿瘤一样安全，大肿瘤和激素活跃性疾病可能是术中HI的风险因素。对于存在这些风险因素的 PCC，应确定最佳的围手术期处理方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Journal of Urology 医学-泌尿学与肾脏学

CiteScore

4.70

自引率

11.50%

发文量

340

审稿时长

3 months

期刊介绍： International Journal of Urology is the official English language journal of the Japanese Urological Association, publishing articles of scientific excellence in urology. Submissions of papers from all countries are considered for publication. All manuscripts are subject to peer review and are judged on the basis of their contribution of original data and ideas or interpretation.