Challenging preoperative α-blockade in pheochromocytoma surgery: beyond tradition, towards 'safer surgery'.

Abstract

The rarity of pheochromocytomas has left a gap in evidence supporting guideline recommendations for preoperative α-blockade dose-escalation. Despite recent studies questioning its efficacy, randomized controlled trials (RCTs) are warranted before considering omitting preoperative α-blockade dose-escalation. Through an online survey, opinions on the ideal study design for this future RCT were gathered from specialists involved in pheochromocytoma management in The Netherlands. Responses from 23 physicians suggest a non-inferiority-designed RCT that only excludes patients with severe comorbidities and incorporates clinical outcome measures as most suitable design. The survey furthermore revealed diverse opinions regarding study design and perioperative threats, emphasizing the importance of an inclusive, multidisciplinary approach in future research.