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. Patients and 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. Conclusion: 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.