title: Surgical and Hemodynamic Outcomes in Pheochromocytoma Surgery: A Prospective Cohort Study.
abstract: OBJECTIVE
  To prospectively evaluate the surgical complications of pheochromocytoma and paraganglioma surgery and assess perioperative hemodynamic outcomes in terms of risk for intraoperative vasodilator use and risk for postoperative vasopressor requirements in these patients.
  
  
  METHODS
  This was an institutional review board-approved prospective observational study of patients undergoing pheochromocytoma or paraganglioma surgery. Operative and recovery data for all patients undergoing open, laparoscopic, and robotic surgery were analyzed for surgical complications on the modified Clavien-Dindo classification. The need for intraoperative vasodilators for pressure spikes of greater than 180 mmHg and vasopressor support after surgery was recorded. Factors predictive of these parameters were assessed.
  
  
  RESULTS
  Forty patients underwent 45 procedures including five bilateral adrenalectomies over the 2-year study period. This included 40 adrenalectomies and 5 paraganglioma excisions. Twenty-nine patients had minimally invasive surgery (25 laparoscopic, 4 robot-assisted) and 11 had open surgery. Sixty percent of patients required intraoperative vasodilators for hypertensive crisis, and this was significantly related to the size of the tumor (P = .02). The need for postoperative vasopressors was related to the number of intraoperative pressure spikes (P = .007). Five percent of the patients suffered a complication greater than grade 2 on the Clavien-Dindo classification.
  
  
  CONCLUSIONS
  Pheochromocytoma and paraganglioma surgeries are associated with minimal postoperative morbidity. Larger tumors may be associated with greater intraoperative pressure surges, but this does not impact patient outcomes.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Niren
authors.initials: N
authors.lastname: Rao
authors.affiliation: Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Ramachandran
authors.affiliation: Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: rajeev02@gmail.com.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000503:physiopathology / Q000601:surgery*; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult