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Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach

Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-bl...

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Autores principales: Buscemi, Salvatore, Di Buono, Giuseppe, D’Andrea, Rocco, Ricci, Claudio, Alberici, Laura, Querci, Lorenzo, Selva, Saverio, Minni, Francesco, Citarrella, Roberto, Romano, Giorgio, Agrusa, Antonino
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397195/
https://www.ncbi.nlm.nih.gov/pubmed/34442056
http://dx.doi.org/10.3390/jcm10163759
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author Buscemi, Salvatore
Di Buono, Giuseppe
D’Andrea, Rocco
Ricci, Claudio
Alberici, Laura
Querci, Lorenzo
Selva, Saverio
Minni, Francesco
Citarrella, Roberto
Romano, Giorgio
Agrusa, Antonino
author_facet Buscemi, Salvatore
Di Buono, Giuseppe
D’Andrea, Rocco
Ricci, Claudio
Alberici, Laura
Querci, Lorenzo
Selva, Saverio
Minni, Francesco
Citarrella, Roberto
Romano, Giorgio
Agrusa, Antonino
author_sort Buscemi, Salvatore
collection PubMed
description Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, without alfa-blockers. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Univariate and multivariate analysis was conducted. A p-value < 0.05 was considered statistically significant. Results: Major postoperative complications were similar (p = 0.49). Advanced hemostatic agents were 44.9% in Group 1 and 100% in Group 2 (p < 0.001). In Group 2, no patients were admitted to the ICU, while only 73.5% of Group 1 (p < 0.001) were admitted. The median length of stay was larger in Group 1 than in Group 2 (p = 0.026). At the induction, SBP was 130 mmHg in Group 1, and 115 mmHg (p < 0.001). The pre-surgery treatment was the only almost statistically significant variable at the multivariate analysis of DBP at the end of surgery. Conclusion: The preoperative use of alfa-blockers should be considered not a dogma in PCC.
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spelling pubmed-83971952021-08-28 Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach Buscemi, Salvatore Di Buono, Giuseppe D’Andrea, Rocco Ricci, Claudio Alberici, Laura Querci, Lorenzo Selva, Saverio Minni, Francesco Citarrella, Roberto Romano, Giorgio Agrusa, Antonino J Clin Med Article Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, without alfa-blockers. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Univariate and multivariate analysis was conducted. A p-value < 0.05 was considered statistically significant. Results: Major postoperative complications were similar (p = 0.49). Advanced hemostatic agents were 44.9% in Group 1 and 100% in Group 2 (p < 0.001). In Group 2, no patients were admitted to the ICU, while only 73.5% of Group 1 (p < 0.001) were admitted. The median length of stay was larger in Group 1 than in Group 2 (p = 0.026). At the induction, SBP was 130 mmHg in Group 1, and 115 mmHg (p < 0.001). The pre-surgery treatment was the only almost statistically significant variable at the multivariate analysis of DBP at the end of surgery. Conclusion: The preoperative use of alfa-blockers should be considered not a dogma in PCC. MDPI 2021-08-23 /pmc/articles/PMC8397195/ /pubmed/34442056 http://dx.doi.org/10.3390/jcm10163759 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Buscemi, Salvatore
Di Buono, Giuseppe
D’Andrea, Rocco
Ricci, Claudio
Alberici, Laura
Querci, Lorenzo
Selva, Saverio
Minni, Francesco
Citarrella, Roberto
Romano, Giorgio
Agrusa, Antonino
Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach
title Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach
title_full Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach
title_fullStr Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach
title_full_unstemmed Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach
title_short Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach
title_sort perioperative management of pheochromocytoma: from a dogmatic to a tailored approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397195/
https://www.ncbi.nlm.nih.gov/pubmed/34442056
http://dx.doi.org/10.3390/jcm10163759
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