Cardiovascular events in elderly phaeochromocytoma patients: medical verses operative management

Background Surgery is the standard treatment for phaeochromocytoma but carries significant risks. Accurate risk benefit ratio of surgery remains unclear in older patients, due to limited comparative data on operative versus non-operative management in the elderly cohort. This study compares cardiovascular event rates and mortality between these approaches in patients aged >65 at a tertiary referral centre. Method This retrospective review identified all phaeochromocytoma patients aged >65 years from MDT records and confirmed against laboratory catecholamine levels. Patient records were analysed for outcomes on complications, mortality, cardiovascular events, Charlson Comorbidity index (CCI). Results Of 55 patients, 31 underwent surgery and 24 received medical management. The non-operative group was significantly older (mean 80 versus 71 years) and higher comorbidity (CCI 5.4 versus 3.7; predicted 10-year survival 22% versus 60%). Lesion size was comparable (mean 47 mm). Over a mean follow-up of 33 months, non-operated patients had greater all-cause mortality (75% versus 6.4%; OR 43.50, 95% c.i. 7.91–239.31, P < 0.0001) and higher cardiovascular event incidence (8 events versus 1 event; OR 15.00, 95% c.i. 1.72–130.89, P = 0.014). Five (16%) operated patients experienced operative complications. Conclusion Elderly phaeochromocytoma patients managed medically demonstrate a significantly greater risk of cardiovascular event or death, compared with operated patients. This data suggests the need for larger prospective studies to ascertain whether we are unnecessarily denying this group surgery.