Comparison of Two Preoperative Medical Management Strategies for Laparoscopic Resection of Pheochromocytoma

Objectives To compare the intraoperative and postoperative course of patients undergoing laparoscopic pheochromocytoma resection at 2 institutions (Mayo Clinic and Cleveland Clinic) with differing approaches to preoperative preparation. Patients undergoing adrenalectomy for pheochromocytoma typicall...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2010-08, Vol.76 (2), p.508.e6-508.e11
Main Authors: Weingarten, Toby N, Cata, Juan P, O'Hara, Jerome F, Prybilla, David J, Pike, Tasha L, Thompson, Geoffrey B, Grant, Clive S, Warner, David O, Bravo, Emmanuel, Sprung, Juraj
Format: Article
Language:English
Subjects:
Adrenal Gland Neoplasms - surgery
Adrenalectomy - methods
Female
Humans
Laparoscopy
Male
Middle Aged
Pheochromocytoma - surgery
Preoperative Care - methods
Retrospective Studies
Urology
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Summary:Objectives To compare the intraoperative and postoperative course of patients undergoing laparoscopic pheochromocytoma resection at 2 institutions (Mayo Clinic and Cleveland Clinic) with differing approaches to preoperative preparation. Patients undergoing adrenalectomy for pheochromocytoma typically undergo a preoperative preparation to normalize their blood pressure and intravascular volume. However, no consensus has been reached regarding the best preoperative preparation regimen. Methods A retrospective chart review was performed of 50 Mayo Clinic patients and 37 Cleveland Clinic patients who had undergone laparoscopic pheochromocytoma resection. Mayo Clinic predominantly used the long-lasting nonselective α1,2 antagonist phenoxybenzamine, and Cleveland Clinic predominately used selective α1 blockade. Data regarding the intraoperative hemodynamics and postoperative complications were collected. Results Almost all patients at Mayo Clinic received phenoxybenzamine (98%). At Cleveland Clinic, the predominant treatment (65%) was selective α1 blockade (doxazosin, terazosin, or prazosin). Intraoperatively, patients at Cleveland Clinic had a greater maximal systolic blood pressure (209 ± 44 mm Hg versus 187 ± 30 mm Hg, P = .011) and had received a greater amount of intravenous crystalloid (median 5000, interquartile range 3400-6400, versus median 2977, interquartile range 2000-3139; P
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2010.03.032