Presentation Authors: Toshikazu Takeda*, Kimiharu Takamatsu, Yu Teranishi, Kyohei Hakozaki, Nobuyuki Tanaka, Kazuhiro Matsumoto, Shinya Morita, Takeo Kosaka, Ryuichi Mizuno, Toshiaki Shinojima, Eiji Kikuchi, Hiroshi Asanuma, Mototsugu Oya, Tokyo, Japan
Introduction: Pheochromocytoma is a rare neuroendocrine tumor that secretes catecholamines and mainly originates in the adrenal grand. Surgical resection is the only curative therapy for pheochromocytoma; however, it is associated with a risk of the massive release of catecholamines, which causes extremely high blood pressure. Furthermore, tumor resection resulting in the acute withdrawal of catecholamines leads to hypotension and shock. In the present study, we evaluated factors affecting hemodynamic instability (HI) during laparoscopic adrenalectomy for pheochromocytoma.
Methods: Fifty-three patients who underwent laparoscopic adrenalectomy for pheochromocytoma between March 2009 and October 2018 were evaluated. We excluded 10 patients who did not have detailed 24-hour urinary data. The administration of a non-selective Î±-adrenergic receptor blocker was initiated preoperatively in all patients. We defined HI as extremely high or low blood pressure during surgery, with systolic blood pressure higher than 200 mmHg or lower than 80 mmHg. We examined factors affecting HI during laparoscopic adrenalectomy for pheochromocytoma.
Results: There were 20 males and 23 females with an average age of 50.6 years. Tumors localized on the left adrenal in 22 cases, on the right in 18, and bilaterally in 3. The average tumor diameter was 43.1 mm (13.0-120.0 mm). Eleven out of 43 patients (26%) developed HI. Nine patients had systolic blood pressure â‰¥200 mmHg and 2 had systolic blood pressure < 80 mmHg during surgery. The mean age of patients was significantly higher among those with than among those without HI (60.3 vs 47.1 years, p=0.04). Mean 24-hour urinary adrenaline (161.2 vs 69.3 Î¼g/day, p < 0.01) and metanephrine (2.19 vs 1.24 mg/day, p=0.01) levels were significantly higher in patients with HI. Gender, tumor laterality, tumor size, plasma catecholamine levels, 24-hour urinary noradrenaline and dopamine levels, 24-hour urinary normetanephrine levels, and urinary vanillylmandelic acid levels did not accurately predict HI.
Conclusions: Surgeons and anesthesiologists need to be aware of the risk of HI at the time of surgery for elderly patients with high 24-hour urinary adrenaline or metanephrine levels.