Pheochromocytoma and Hemodynamic Instability

Overview

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.

Full Title of Study: “Risk Factors for Hemodynamic Instability During Laparoscopic Pheochromocytoma Resection – Single Centre Experience”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: December 2019

Detailed Description

The study was a retrospective observation of consecutive patients with histologically confirmed pheochromocytoma undergoing laparoscopic adrenalectomy between years 2003 and 2019.

Interventions

  • Procedure: Laparoscopic 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.

Clinical Trial Outcome Measures

Primary Measures

  • Number of Participants with Hemodynamic Instability (n, %)
    • Time Frame: 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 Measures

  • Number of Complications in Patients (n, %)
    • Time Frame: Within 30 days after surgery
    • Data on morbidity were classified according to the Clavien-Dindo classification.
  • Number of Cardiovascular Complications in Patients (n, %)
    • Time Frame: 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.

Participating in This Clinical Trial

Inclusion Criteria

  • patients with histologically confirmed pheochromocytoma undergoing laparoscopic adrenalectomy Exclusion Criteria:

  • bilateral tumour – no histopathological result – neoplastic spread

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Jagiellonian University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Karolina Zawadzka, Principal Investigator – Jagiellonian University

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