Intraoperative haemodynamic stability in patients with phaeochromocytoma--minimally invasive vs conventional open surgery.
OBJECTIVE
There is conflicting evidence, whether or not minimally invasive adrenalectomy (MA) is associated with an increased perioperative cardiovascular instability in phaeochromocytomas compared to conventional open adrenalectomy (CA).


METHODS
In a retrospective analysis of 49 patients with phaeochromocytoma we compared 27 cases of MA to 22 cases of CA by assessing intraoperative haemodynamic parameters and perioperative complications. Patients undergoing MA for adrenocortical adenomas (aldosteronomas n = 15, inactive adenomas n = 13) served as controls. Additionally, we investigated the effect of phenoxybenzamine (POB) pretreatment on intraoperative cardiovascular stability in 42 patients (ranked by maximum daily POB-dose) by comparing the highest (n = 10) with the lowest (n = 10) POB dose quartile (0.32 +/- 0.2 and 2.17 +/- 0.6 mg/kg/day, P < 0.001).


RESULTS
In phaeochromocytomas we found no significant difference in intraoperative haemodynamic parameters or complications when comparing MA with CA. In comparison to adrenocortical adenomas, MA in phaeochromocytomas was associated with a significantly higher maximum systolic BP (188 +/- 29 vs 154 +/- 22 mmHg, P < 0.001), more frequent hypertensive episodes (1[0-4]vs 0[0-1], P < 0.001), more episodes of systolic BP > 200 mmHg (0[0-4]vs 0[0-1], P = 0.03) and a higher demand for intraoperative fluids (3194 ml vs 1750 ml, P < 0.001). Most haemodynamic parameters did not differ significantly between high-dose POB pretreatment and low-dose POB pretreatment, but high-dose POB pretreatment was associated with a significantly higher intraoperative heart rate (120 +/- 19.5 vs 94 +/- 15.2 min(-1), P < 0.01).


CONCLUSIONS
There is no significant difference in haemodynamic stability between MA and CA in phaeochromocytomas, but it is significantly inferior when compared to MA for cortical adenomas. We could not detect a beneficial effect of high-dose compared to low-dose POB pretreatment on intraoperative cardiovascular stability.
Weismann
Dirk
D
Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, Wuerzburg, Germany.
Fassnacht
Martin
M
Weinberger
Fabian
F
Hamelmann
Wulf
W
Diehl
Saskia
S
Lorenz
Kerstin
K
Baerlehner
Eckhard
E
Reincke
Martin
M
Beuschlein
Felix
F
Knoefel
Wolfram
W
Nies
Christoph
C
Hahner
Stefanie
S
Allolio
Bruno
B
D000236:Adenoma / Q000503:physiopathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D001794:Blood Pressure; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010643:Phenoxybenzamine / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery*; D011300:Preoperative Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D000317:Adrenergic alpha-Antagonists; D010643:Phenoxybenzamine