Impact of surgical technique on hemodynamic instability in patients with pheochromocytoma: a single-centre retrospective cohort study.

Background: Endoscopic adrenalectomy by either transperitoneal laparoscopic (TLA) or posterior retroperitoneoscopic approach (PRA) is the preferred treatment for pheochromocytoma (PCC). PRA shows advantages in patient outcome, but blood pressure fluctuations may occur due to limited working space and increased CO-pressure. We investigated the impact of surgical technique on intraoperative hemodynamic instability in patients with PCC.

Methods: Patients who had endoscopic adrenalectomy for PCC consecutively from 2007 to 2022 were included in this retrospective cohort study. The primary outcome was hemodynamic instability (HI-score) and secondary outcomes were hemodynamic parameters and drug administration.

Results: Overall, 101 patients met the inclusion criteria, 57 had TLA and 44 PRA. The two groups were similar in baseline characteristics. The HI-score was higher in PRA than in TLA (97 vs 46, p < 0.001) due to more frequent (IQR: 2-5 vs IQR: 1-3, p = 0.025) and longer episodes of hypotension (5.6% vs 7.1%, p = 0.013), and longer episodes of bradycardia (9.9% vs 16.9%, p = 0.038). On the contrary, TLA patients had higher maximum systolic blood pressure (169 mmHg vs 157 mmHg, p = 0.046), more frequent episodes of tachycardia (31.6% vs 6.8%, p = 0.002) and higher maximum heart rate (90 bpm vs 80 bpm, p = 0.024). PRA patients needed more vasoconstrictive drugs (97.7% vs 78.9%, p = 0.017) and fluid infusion (1111 ml/h vs 798 ml/h, p = 0.004), whereas TLA patients received more vasodilating drugs (64.9% vs 38.6%, p = 0.009).

Conclusions: PRA was associated with higher hemodynamic instability than TLA reflected by hypotension, need for vasoconstrictive drugs and fluid infusion in a selected cohort of patients with pheochromocytoma.