학술논문
Differences in intraoperative and surgical outcomes between normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs) and hypertensive PPGLs: results from the PHEO-RISK STUDY
Document Type
Original Paper
Author
Araujo-Castro, M.; García Sanz, I.; Mínguez Ojeda, C.; Calatayud, M.; Hanzu, F.; Mora, M.; Vicente, A.; Blanco Carrera, C.; De Miguel Novoa, P.; López García, M. del Carmen; Manjón-Miguélez, L.; Rodríguez de Vera, P.; del Castillo Tous, M.; Barahona San Millán, R.; Recasens, M.; Tomé Fernández-Ladreda, M.; Valdés, N.; Gracia Gimeno, P.; Robles Lazaro, C.; Michalopoulou, T.; Álvarez Escolá, C.; García Centeno, R.; Lamas, C.
Source
Journal of Endocrinological Investigation: Official Journal of Italian Society of Endocrinology (SIE). 46(4):805-814
Subject
Language
English
ISSN
1720-8386
Abstract
Purpose: To compare the intraoperative and surgical outcomes of normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs), hypertensive PPGLs and non-PPGL adrenal lesions.Methods: This a retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. A control group of histologically confirmed adrenocortical adenomas (non-PPGL group) was selected to compare intraoperative and surgical outcomes with of the normotensive PPGLs.Results: Two hundred and ninety-six surgeries performed in 289 patients with PPGLs were included. Before surgery, 209 patients were classified as hypertensive PPGLs (70.6%) and 87 as normotensive PPGLs. A higher proportion of normotensive PPGLs than hypertensive PPGLs did not receive alpha presurgical blockade (P = 0.009). When we only considered those patients who received presurgical alpha blockers (200 hypertensive PPGLs and 76 normotensive PPGLs), hypertensive PPGLs had a threefold higher risk of intraoperative hypertensive crisis (OR 3.0 [95% 1.3–7.0]) and of hypotensive episodes (OR 2.9 [95% CI 1.2–6.7]) than normotensive PPGLs. When we compared normotensive PPGLs (n = 76) and non-PPGLs (n = 58), normotensive PPGLs had a fivefold higher risk of intraoperative complications (OR 5.3 [95% CI 1.9–14.9]) and a six times higher risk of postoperative complications (OR 6.1 [95% CI 1.7–21.6]) than non-PPGLs.Conclusion: Although the risk of intraoperative hypertensive and hypotensive episodes in normotensive PPGLs is significantly lower than in hypertensive PPGLs, normotensive PPGLs have a greater risk of intraoperative and postoperative complications than non-PPGL adrenal lesions. Therefore, it is recommended to follow the standard of care for presurgical and anesthetic management of PPGLs also in normotensive PPGLs.