Purpose

To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery.

Methods

A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale.

Results

One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P = 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82, P < 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n = 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm.

Conclusion

Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications.

中文翻译：

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嗜铬细胞瘤手术的手术结果。PHEO-RISK 研究结果

目的

确定嗜铬细胞瘤手术中术后并发症的术前和手术危险因素。

方法

一项关于 2011 年至 2021 年间在西班牙 10 家医院接受手术的嗜铬细胞瘤的回顾性研究。根据 Clavien-Dindo 量表对术后并发症进行分类。

结果

包括 162 次手术（159 名患者）。95.1% 的患者进行了术前降压阻断，其中多沙唑嗪单药治疗（43.8%）是最常见的治疗方案。与使用苯氧苯甲胺治疗的患者相比，预先接受多沙唑嗪治疗的患者需要术中降压治疗的频率更高（49.4% vs 25.0%，P  = 0.003），但未观察到术中和术后并发症发生率的差异。然而，接受苯氧苄明治疗的患者住院时间更长（12.2 ± 11.16 vs 6.2 ± 6.82，P < 0.001) 比用多沙唑嗪治疗的那些。78.7%的患者高血压消退，96.6%的患者生化治愈。31 名患者 (19.1%) 有术后并发症。长期低血压是最常见的，占 9.9%（n  = 16），其次是 6 名患者的低血糖和 4 名患者的急​​性肾功能衰竭。13.0% 的并发症在 Clavien-Dindo 量表中得分≥3。糖尿病、脑血管疾病、血糖水平较高、尿游离甲肾上腺素和去甲肾上腺素较高以及嗜铬细胞瘤大于5 cm的患者术后并发症更为常见。

结论

对于糖尿病、脑血管疾病、血浆葡萄糖和尿中游离去甲肾上腺素和去甲肾上腺素水平较高的患者以及嗜铬细胞瘤>5 cm的患者，由于术后并发症的风险较高，术前药物治疗和术后监测应特别小心。