Skip to main content
SpringerLink
Log in

Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Since the 1950s, preoperative medical preparation has been widely applied in patients with pheochromocytoma to improve intraoperative hemodynamic instability and postoperative complications. However, advancements in preoperative imaging, laparoscopic surgical techniques, and anesthesia have considerably improved management in patients with pheochromocytoma. In consequence, there is no validated consensus on current predictive factors for postoperative morbidity. The aim of this study was to determine perioperative factors which are predictive for postoperative morbidity in patients undergoing laparoscopic adrenalectomy for pheochromocytoma.

Study design

It is a retrospective analysis of prospectively maintained databases in five medical centers from 2002 to 2013. Inclusion criteria were consecutive patients who underwent non-converted laparoscopic unilateral total adrenalectomy for pheochromocytoma.

Results

Two-hundred and twenty-five patients were included. All-cause and cardiovascular postoperative morbidity rates were 16 % (n = 36) and 4.8 % (n = 11), respectively. Preinduction blood pressure normalization after preoperative medical preparation had no impact on postoperative morbidity. However, past medical history of coronary artery disease (OR [CI95 %] = 3.39; [1.317–8.727]) and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 160 mmHg and MAP < 60 mmHg) (OR [CI95 %] = 3.092; [1.451–6.587]) remained independent predictors for postoperative all-cause morbidity. Similarly, past medical history of coronary artery disease (OR [CI95 %] = 14.41; [3.119–66.57]), female sex (OR [CI95 %] = 12.05; [1.807–80.31]), and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 200 mmHg and MAP < 60 mmHg) (OR [CI95 %] = 4.13; [1.009–16.90]) remained independent predictors for postoperative cardiovascular morbidity.

Conclusions

This study identifies risk factors for cardiovascular and all-cause postoperative morbidity after laparoscopic adrenalectomy in current clinical setting. These data can help physicians to guide intra-operative blood pressure management and have to be taken into account in further studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kercher K, Novitsky Y, Park A, Matthews B, Litwin D, Heniford B (2005) Laparoscopic resection in pheochromocytomas. Ann Surg 241:919–926

  2. Duh QY (2001) Evolving surgical management for patients with pheochromocytoma. J Clin Endocrinol Metab 86:1477–1479

    Article  CAS  PubMed  Google Scholar 

  3. Lentschener C, Gaujoux S, Tesniere A, Dousset B (2011) Point of controversy: perioperative care of patients undergoing pheochromocytoma removal—time for reappraisal ? Eur J Endocrinol 165:365–373

    Article  CAS  PubMed  Google Scholar 

  4. Bruynzeel H, Feelders R, Groenland TH, Van der Meiracker A, Van Eijck C, Lange J et al (2010) Risk factors for hemodynamic instability during surgery for pheochromocytoma. J Clin Endocrinol Metab 95:678–685

    Article  CAS  PubMed  Google Scholar 

  5. Kierman CM, Du L, Chen X, Broome JT, Chanjuan S, Peters MF, et al (2014) Predictors of hemodynamic instability during surgery for pheochromocytoma. Ann Surg Oncol. Published online 18 June 2014. doi 10.1245/s10434-014-3847-7

  6. Siddiqi H, Yang H, Laird A, Fox A, Doherty G, Miller B et al (2012) Utility of oral nicardipine and magnesium sulfate infusion during preparation and resection of pheochromocytomas. Surgery. 152:1027–1036

    Article  PubMed  Google Scholar 

  7. Kinney M, Narr BJ, Warmer MA (2002) Perioperative management of pheochromocytoma. J Cardiothorac Vasc Anesth 16:359–369

    Article  PubMed  Google Scholar 

  8. Kvale WF, Roth GM, Manger WM, Priestley JT (1956) Pheochromocytoma. Circulation 14:622–630

    Article  CAS  PubMed  Google Scholar 

  9. Roizen MF, Schreider BD, Hassan SZ (1987) Anesthesia for patients with pheochromocytoma. Anesthesiol Clin North Am 5:269–275

    Google Scholar 

  10. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH et al (2014) Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:1915–1942

    Article  CAS  PubMed  Google Scholar 

  11. Combemale F, Carnaille B, Tavernier B, Hautier M, Thevenot A, Scherpereel P et al (1998) Exclusive use of calcium channel blockers and cardioselective beta-blockers in the pre- and per-operative management of pheochromocytomas. Ann Chir 52:341–345

    CAS  PubMed  Google Scholar 

  12. Brunaud L, Boutami M, Nguyen PL, Finnerty B, Germain A, Weryha G et al (2014) Both preoperative Alpha and Calcium channel blockade impact intraoperative hemodynamic stability similarly in the management of pheochromocytoma. Surgery 156:1410–1418

    Article  PubMed  Google Scholar 

  13. Weingarten T, Cata J, O’Hara J, Prybilla D, Pike T, Thompson G et al (2010) Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. Urology 76:e6–e11

    PubMed  Google Scholar 

  14. Lebuffe G, Dosseh D, Tek G, Tytgat H, Moreno S, Tavernier B et al (2005) The effect of calcium channel blockers on outcome following the surgical treatment of phaechromocytomas and paragangliomas. Anesthesia 60:439–444

    Article  CAS  Google Scholar 

  15. Inabnet WB, Pitre J, Bernard D, Chapuis Y (2000) Comparison of the hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma. World J Surg 24:574–578

    Article  CAS  PubMed  Google Scholar 

  16. Sprung J, O’Hara JF Jr, Gill IS, Abdelmalak B, Sarnaik A (2000) EL. B. Anesthetic aspects of laparoscopic and open adrenalectomy for pheochromocytoma. Urology 55:339–343

    Article  CAS  PubMed  Google Scholar 

  17. Scholten A, Vriens M, Cromheecke G, Rinkes IH, Valk GD (2011) Hemodynamic instability during resection of pheochromocytoma in MEN versus non-NEM patients. Eur J Endocrinol 165:91–96

    Article  CAS  PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  19. Kazic MR, Zivaljevic VR, Milan ZB, Paunovic IR (2011) Perioperative risk factors, morbidity, and outcomes of 145 patients during phaeochromocytoma resection. Acta Chir Belg 111:223–227

    CAS  PubMed  Google Scholar 

  20. Dickson P, Alex G, Grubbs E, Ayala-Ramirez M, Jimenez C, Evans D et al (2011) Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery 150:452–458

    Article  PubMed  Google Scholar 

  21. Lang B, Fu B, Ouyang JZ, Wang B, Zhang G, Xu K et al (2008) Retrospective comparison of retroperitoneoscopic versus open adrenalectomy for pheochromocytoma. J Urol 179:57–60

    Article  PubMed  Google Scholar 

  22. Stolk R, Bakx C, Mulder J, Timmers H, Lenders JW (2013) Is the excess cardiovascular morbidity in pheochromocytoma related to blood pressure or to catecholamines? J Clin Endocrinol Metab 98:1100–1106

    Article  CAS  PubMed  Google Scholar 

  23. Solozarno CC, Lew JL, Wilhelm S, Sumner W, Huang W, Wu W et al (2007) Outcomes of pheochromocytoma management in the laparoscopic era. Ann Surg Oncol 14:3004–3010

    Article  Google Scholar 

  24. Zhang X, Lang B, Ouyang JZ, Fu B, Zhang J, Xu K et al (2007) Retroperitoneoscopic adrenalectomy without previous control of adrenal vein is feasible and safe for pheochromocytoma. Urology 69:849–853

    Article  PubMed  Google Scholar 

  25. Walz M, Alesina P, Wenger F, Koch J, Neumann H, Petersenn S et al (2006) Laparoscopic and retroperitoneoscopic treatment of pheochromocytomas and retroperitoneal paraganglioma: results of 161 tumors in 126 patients. World J Surg 30:899–908

    Article  PubMed  Google Scholar 

  26. Shen W, Grogan R, Vriens M, Clark O, Duh QY (2010) One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg 145:893–897

    Article  PubMed  Google Scholar 

  27. Lentschener C, Gaujoux S, Thillois JM, Duboc D, Bertherat J, Ozier Y et al (2009) Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaechromocytoma. Acta Anaesthesiol Scand 53:522–527

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Brunaud, Nguyen-Thi, Mirallie, Raffaelli, Vriens, Theveniaud, Boutami, Finnerty, Vorselaars, Borel Rinkes, Bellantone, Lombardi, Fahey, Zarnegar, and Bresler have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy—Hospital Brabois Adultes, Université de Lorraine, Hopital Brabois Adultes (3ème étage), 11 allée du morvan, 54511, Vandoeuvre-Les-Nancy, France

    Laurent Brunaud, Pierre-Etienne Theveniaud & Laurent Bresler

  2. Faculty of medicine, Université de Lorraine, INSERM U954, Vandoeuvre-Les-Nancy, France

    Laurent Brunaud

  3. CHU Nancy, Clinical Epidemiology and Evaluation Department, ESPRI, Université de Lorraine, Vandoeuvre-Les-Nancy, France

    Phi-Linh Nguyen-Thi

  4. Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Nantes, France

    Eric Mirallie & Myriam Boutami

  5. Division of Endocrine and Metabolic Surgery, Istituto di Semiotica Chirurgica, Universita Cattolica del Sacro Cuore, Policlinico “A Gemelli”, L.go A. Gemelli 8, 00168, Rome, Italy

    Marco Raffaelli, Rocco Bellantone & Celestino Lombardi

  6. Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, 3584 CX, The Netherlands

    Menno Vriens, Wessel M. C. M. Vorselaars & Inne Borel Rinkes

  7. Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA

    Brendan M. Finnerty, Thomas Fahey III & Rasa Zarnegar

Authors
  1. Laurent Brunaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Phi-Linh Nguyen-Thi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Mirallie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Raffaelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Menno Vriens
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pierre-Etienne Theveniaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Myriam Boutami
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brendan M. Finnerty
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wessel M. C. M. Vorselaars
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Inne Borel Rinkes
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rocco Bellantone
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Celestino Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Thomas Fahey III
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Rasa Zarnegar
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Laurent Bresler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laurent Brunaud.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brunaud, L., Nguyen-Thi, PL., Mirallie, E. et al. Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients. Surg Endosc 30, 1051–1059 (2016). https://doi.org/10.1007/s00464-015-4294-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4294-7

Keywords

Search

Navigation