Hemodynamic instability during surgery for pheochromocytoma: comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients

Wessel M.C.M. Vorselaars, Emily L. Postma, Eric Mirallie, Julien Thiery, Mattan Lustgarten, Jesse D. Pasternak, Rocco Bellantone, Marco Raffaelli, Thomas Fahey, Menno R. Vriens, Laurent Bresler, Laurent Brunaud, Rasa Zarnegar

Research output: Contribution to journalArticle

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Abstract

Background Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort. Methods Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator. Results In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134–34.235, P =.035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions. Conclusion Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.

Original languageEnglish
Pages (from-to)176-182
Number of pages7
JournalSurgery (United States)
Volume163
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Adrenalectomy
Pheochromocytoma
Hemodynamics
Arterial Pressure
Blood Pressure
Vasodilator Agents
Multivariate Analysis
Anesthesia
Odds Ratio
Confidence Intervals
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Hemodynamic instability during surgery for pheochromocytoma : comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients. / Vorselaars, Wessel M.C.M.; Postma, Emily L.; Mirallie, Eric; Thiery, Julien; Lustgarten, Mattan; Pasternak, Jesse D.; Bellantone, Rocco; Raffaelli, Marco; Fahey, Thomas; Vriens, Menno R.; Bresler, Laurent; Brunaud, Laurent; Zarnegar, Rasa.

In: Surgery (United States), Vol. 163, No. 1, 01.01.2018, p. 176-182.

Research output: Contribution to journalArticle

Vorselaars, WMCM, Postma, EL, Mirallie, E, Thiery, J, Lustgarten, M, Pasternak, JD, Bellantone, R, Raffaelli, M, Fahey, T, Vriens, MR, Bresler, L, Brunaud, L & Zarnegar, R 2018, 'Hemodynamic instability during surgery for pheochromocytoma: comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients', Surgery (United States), vol. 163, no. 1, pp. 176-182. https://doi.org/10.1016/j.surg.2017.05.029
Vorselaars, Wessel M.C.M. ; Postma, Emily L. ; Mirallie, Eric ; Thiery, Julien ; Lustgarten, Mattan ; Pasternak, Jesse D. ; Bellantone, Rocco ; Raffaelli, Marco ; Fahey, Thomas ; Vriens, Menno R. ; Bresler, Laurent ; Brunaud, Laurent ; Zarnegar, Rasa. / Hemodynamic instability during surgery for pheochromocytoma : comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients. In: Surgery (United States). 2018 ; Vol. 163, No. 1. pp. 176-182.
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abstract = "Background Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort. Methods Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator. Results In total, 341 patients met the inclusion criteria, 101 (29.6{\%}) underwent retroperitoneal adrenalectomy and 240 (70.4{\%}) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134–34.235, P =.035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions. Conclusion Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.",
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T2 - comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients

AU - Vorselaars, Wessel M.C.M.

AU - Postma, Emily L.

AU - Mirallie, Eric

AU - Thiery, Julien

AU - Lustgarten, Mattan

AU - Pasternak, Jesse D.

AU - Bellantone, Rocco

AU - Raffaelli, Marco

AU - Fahey, Thomas

AU - Vriens, Menno R.

AU - Bresler, Laurent

AU - Brunaud, Laurent

AU - Zarnegar, Rasa

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N2 - Background Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort. Methods Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator. Results In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134–34.235, P =.035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions. Conclusion Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.

AB - Background Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort. Methods Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator. Results In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134–34.235, P =.035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions. Conclusion Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.

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