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- Title
Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients.
- Authors
Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Mirallie, Eric; Raffaelli, Marco; Vriens, Menno; Theveniaud, Pierre-Etienne; Boutami, Myriam; Finnerty, Brendan; Vorselaars, Wessel; Rinkes, Inne; Bellantone, Rocco; Lombardi, Celestino; Fahey, Thomas; Zarnegar, Rasa; Bresler, Laurent; Finnerty, Brendan M; Vorselaars, Wessel M C M; Rinkes, Inne Borel; Fahey, Thomas 3rd
- Abstract
<bold>Background: </bold>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.<bold>Study Design: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
DISEASE research; DIAGNOSIS; ADRENALECTOMY; ADRENAL surgery; PHEOCHROMOCYTOMA; ADRENAL tumors; COMPARATIVE studies; LAPAROSCOPY; RESEARCH methodology; MEDICAL cooperation; RESEARCH; SURGICAL complications; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2016, Vol 30, Issue 3, p1051
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-015-4294-7