OncologyPreoperative Levels of Catecholamines and Metanephrines and Intraoperative Hemodynamics of Patients Undergoing Pheochromocytoma and Paraganglioma Resection
Section snippets
Materials and Methods
The Mayo Clinic Institutional Review Board approved this study. In accordance with Minnesota State Statute 144.335, we included only the patients who provided authorization for research use of their medical records.
Results
Between January 1, 2000, and June 30, 2015, a total of 258 patients with abdominal, pelvic, or thoracic PGL or PCC underwent surgical resection. Patients presented with 48 PGLs and 210 PCCs, of which 49 were resected through open surgical approach and 161 were resected laparoscopically. Table 1 summarizes preoperative demographic characteristics, comorbidities, and relevant preoperative therapies used to prepare patients for surgery. Pharmacologic treatment was administered to 254 patients
Discussion
We determined that patients undergoing PGL-PCC resection have substantial intraoperative hemodynamic oscillations regardless of their preoperative adrenergic activity. Oscillations were more pronounced when preoperative adrenergic activity was more than 2-fold greater than the upper limit of the reference range. Despite the fact that most of our patients were pretreated with PBZ, postoperative hypotension requiring treatment was rare but was more frequent in patients with higher adrenergic
Conclusion
Despite universal preoperative pharmacologic preparation of patients undergoing PGL-PCC resection, substantial hemodynamic variability was present intraoperatively, even in patients with normal or mildly elevated levels of preoperative adrenergic activity. Therefore, we suggest that all patients undergoing thoracic, abdominal, and pelvic PGL-PCC resection should be appropriately prepared with α-adrenergic blockade, regardless of degree of tumoral secretion of catecholamines and metanephrines. A
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2021, The Lancet Diabetes and EndocrinologyCitation Excerpt :Of note, all previous studies were case reports, small case series, or reviews of literature. In addition to the selection and publication biases contributing to higher rates of adverse outcomes in previous studies, the decrease in both maternal and fetal adverse outcomes probably reflects overall improvements in obstetric care and surgical expertise, advances in anaesthesia care, and a higher rate of PPGL discovery based on presymptomatic case detection or incidental diagnosis on imaging, and the availability of α-adrenergic blockade.4,17,20,30 Adverse outcomes occurred more frequently in patients with abdominal or pelvic PPGL compared with other locations, probably due to compression of the tumour by the gravid uterus or the higher degree of catecholamine release in patients with abdominal or pelvic PPGL.
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Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: Support was provided by the Department of Anesthesiology, Mayo Clinic, Rochester, MN.