Hypertension, Pheochromocytoma, Surgery
Conditions
Keywords
pheochromocytoma, laparoscopy, haemodynamics, surgery
Brief summary
The aims of our study were to define perioperative HI during laparoscopic adrenalectomy for pheochromocytoma, assess the incidence of perioperative HI, and identify predictive factors of perioperative HI in our group of patients.
Detailed description
The study was a retrospective observation of consecutive patients with histologically confirmed pheochromocytoma undergoing laparoscopic adrenalectomy between years 2003 and 2019.
Interventions
PROCEDURELaparoscopic adrenalectomy
Preoperative staging in all cases consisted of computed tomography or/and magnetic resonance imaging. Prior to surgery, a routine panel of laboratory tests was carried out. The catecholamines metabolites (metanephrine, normetanephrine, and methoxytyramine) were measured from 24-hour urine collection. All patients were preoperatively treated with phenoxybenzamine or alternative doxazosin.Additionally, beta-blockers in case of coexisting tachycardia were given. In the morning of the operation, preinduction blood pressure was measured. Pneumoperitoneum was achieved by insufflating CO2 gas to an intraperitoneal pressure of 12 mmHg. The operative method in our department was laparoscopic transperitoneal lateral total adrenalectomy. Intraoperatively SBP and diastolic blood pressure (DBP) were measured and recorded every 10 minutes. To treat hypertensive and hypotensive episodes, intravenous doses of urapidil, ephedrine, nitrates, MgSO4, norepinephrine, or ß-blockers were administered.
Sponsors
Jagiellonian University
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients with histologically confirmed pheochromocytoma undergoing laparoscopic adrenalectomy
Exclusion criteria
* bilateral tumour * no histopathological result * neoplastic spread
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants with Hemodynamic Instability (n, %) | intraoperative | Hemodynamic instability was defined as an occurrence of both intraoperative episodes of systolic blood pressure above 160 mm Hg and vasoactive (vasodilators or vasoconstrictors) drugs administration. Patients were divided into two groups: one which met both above criteria, and another one without hemodynamic instability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Complications in Patients (n, %) | Within 30 days after surgery | Data on morbidity were classified according to the Clavien-Dindo classification. |
| Number of Cardiovascular Complications in Patients (n, %) | Within 30 days after surgery | Cardiovascular morbidity was defined as postoperative morbidity related to the cardiovascular system: postoperative hypotensive or hypertensive episodes requiring pharmacologic treatment, need for blood transfusion, myocardial or digestive ischemia, stroke, and postoperative hospitalization in intensive care unit (ICU) for cardiac-related causes. |
Other
| Measure | Time frame |
|---|---|
| Patients needing blood transfusion, n (%) | Intraoperative |
| Mean intraoperative blood loss (ml) | Intraoperative |
| Number of participants who required intraoperative vasodilators administration (n, %) | Intraoperative |
| Number of participants who required intraoperative vasopressors administration (n, %) | Intraoperative |
| Length of hospital stay (days) | Up to 30 days |
| Patients with episodes systolic blood pressure >180 mmHg (n, %) | Intraoperative |
| Patients with episodes systolic blood pressure >160 mmHg (n, %) | Intraoperative |
| Number of participants who required postoperative vasopressorss administration (n, %) | Within 24 hours after surgery |
| Patients with episodes systolic blood pressure >200 mmHg (n, %) | Intraoperative |
| Duration of anaesthesia (min) | Intraoperative |
| Duration of surgery (min) | Intraoperative |
Outcome results
None listed