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-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.