127 Catecholamine-Induced Hypertensive Crisis During Laparoscopic Adrenalectomy for Unilateral Pheochromocytoma

Abstract Background Laparoscopic adrenalectomy (LA) is the standard of care for the management of pheochromocytoma after preoperative medical preparation (PMP) using antihypertensive medications. Catecholamine-induced hypertensive crisis (CIHC) was recently defined by an international consortium as blood pressure 180/120 mmHg. However, the impact of PMP on intraoperative CIHC and perioperative complications remains controversial. The aim of this study was to evaluate the impact of PMP on the incidence of intraoperative CIHC and perioperative complications. Methods Multi-institutional retrospective cohort study including data from all patients who underwent LA for pheochromocytoma in 8 high-volume surgical departments from 01/01/2000 to 12/31/2016. Patients who underwent emergency surgery, bilateral or open adrenalectomy were excluded (n=140). Results Data were available for 922 patients (female n=520, 56.4%). Long-term antihypertensive treatment prior surgery and specific PMP were recorded in 479 (51.9%) and 604 patients (65.5%), respectively. During LA, at least one episode of CIHC was observed in 123 patients (13.7%). Perioperative mortality rate was 0.3% (3 patients). Thirty-day postoperative complication rate was 20.4% (188 patients). In multivariable analysis, tumor size (0.99, 0.98-1.00; p=0.04) remained the only independent predictor for intraoperative CIHC incidence (ASA score, long-term antihypertensive treatment, and PMP had no significant impact). ASA score (2.17, 1.56-3.01; p0.001), tumor size (1.01, 1.00-1.02; p0.01), long-term antihypertensive treatment (1.59, 1.11-2.28; p=0.01), and intraoperative CIHC incidence (0.62, 0.39-0.97; p=0.03) remained independent predictors for perioperative complications, but not PMP. Conclusions The use of PMP had no significant impact on intraoperative CIHC incidence and perioperative complications in this multi-institutional cohort study.