title: Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients.
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.
  
  
  METHODS
  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.
authors.affiliation: 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. l.brunaud@chu-nancy.fr.|Faculty of medicine, Université de Lorraine, INSERM U954, Vandoeuvre-Les-Nancy, France. l.brunaud@chu-nancy.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.affiliation: CHU Nancy, Clinical Epidemiology and Evaluation Department, ESPRI, Université de Lorraine, Vandoeuvre-Les-Nancy, France.
authors.forename: Phi-Linh
authors.initials: PL
authors.lastname: Nguyen-Thi
authors.affiliation: Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallie
authors.affiliation: 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.
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.affiliation: Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, 3584 CX, The Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: Vriens
authors.affiliation: 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.
authors.forename: Pierre-Etienne
authors.initials: PE
authors.lastname: Theveniaud
authors.affiliation: Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Nantes, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Boutami
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Finnerty
authors.affiliation: Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, 3584 CX, The Netherlands.
authors.forename: Wessel M C M
authors.initials: WM
authors.lastname: Vorselaars
authors.affiliation: Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, 3584 CX, The Netherlands.
authors.forename: Inne Borel
authors.initials: IB
authors.lastname: Rinkes
authors.affiliation: 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.
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.affiliation: 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.
authors.forename: Celestino
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fahey
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.affiliation: 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.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bresler
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Adrenalectomy; Blood pressure; Hemodynamics; Morbidity; Pheochromocytoma; Risk factors