Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma

Toby N. Weingarten, Juan P. Cata, Jerome F. O'Hara, David J. Prybilla, Tasha L. Pike, Geoffrey B. Thompson, Clive S. Grant, David Oman Warner, Emmanuel Bravo, Juraj Sprung

Research output: Contribution to journalArticle

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Abstract

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 <.010) and colloid (median 1000, interquartile range 500-1000, versus median 0, interquartile range 0-0; P <.001). At Mayo Clinic, more patients had received phenylephrine (56.0% versus 27.0%, P = .009). No differences were found in the postoperative surgical outcomes, and the hospital stay was comparable between the 2 groups. Conclusions: Differences in the preoperative preparation and intraoperative management were associated with differences in intraoperative hemodynamics but not with clinically significant outcomes in patients undergoing laparoscopic adrenalectomy for pheochromocytoma at 2 large tertiary care centers.

Original languageEnglish (US)
JournalUrology
Volume76
Issue number2
DOIs
StatePublished - Aug 2010

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Pheochromocytoma
Phenoxybenzamine
Terazosin
Adrenalectomy
Blood Pressure
Hemodynamics
Doxazosin
Prazosin
Intraoperative Complications
Colloids
Phenylephrine
Tertiary Care Centers
Length of Stay

ASJC Scopus subject areas

  • Urology

Cite this

Weingarten, T. N., Cata, J. P., O'Hara, J. F., Prybilla, D. J., Pike, T. L., Thompson, G. B., ... Sprung, J. (2010). Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. Urology, 76(2). https://doi.org/10.1016/j.urology.2010.03.032

Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. / Weingarten, Toby N.; Cata, Juan P.; O'Hara, Jerome F.; Prybilla, David J.; Pike, Tasha L.; Thompson, Geoffrey B.; Grant, Clive S.; Warner, David Oman; Bravo, Emmanuel; Sprung, Juraj.

In: Urology, Vol. 76, No. 2, 08.2010.

Research output: Contribution to journalArticle

Weingarten, TN, Cata, JP, O'Hara, JF, Prybilla, DJ, Pike, TL, Thompson, GB, Grant, CS, Warner, DO, Bravo, E & Sprung, J 2010, 'Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma', Urology, vol. 76, no. 2. https://doi.org/10.1016/j.urology.2010.03.032
Weingarten, Toby N. ; Cata, Juan P. ; O'Hara, Jerome F. ; Prybilla, David J. ; Pike, Tasha L. ; Thompson, Geoffrey B. ; Grant, Clive S. ; Warner, David Oman ; Bravo, Emmanuel ; Sprung, Juraj. / Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. In: Urology. 2010 ; Vol. 76, No. 2.
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abstract = "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 <.010) and colloid (median 1000, interquartile range 500-1000, versus median 0, interquartile range 0-0; P <.001). At Mayo Clinic, more patients had received phenylephrine (56.0{\%} versus 27.0{\%}, P = .009). No differences were found in the postoperative surgical outcomes, and the hospital stay was comparable between the 2 groups. Conclusions: Differences in the preoperative preparation and intraoperative management were associated with differences in intraoperative hemodynamics but not with clinically significant outcomes in patients undergoing laparoscopic adrenalectomy for pheochromocytoma at 2 large tertiary care centers.",
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AU - Weingarten, Toby N.

AU - Cata, Juan P.

AU - O'Hara, Jerome F.

AU - Prybilla, David J.

AU - Pike, Tasha L.

AU - Thompson, Geoffrey B.

AU - Grant, Clive S.

AU - Warner, David Oman

AU - Bravo, Emmanuel

AU - Sprung, Juraj

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N2 - 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 <.010) and colloid (median 1000, interquartile range 500-1000, versus median 0, interquartile range 0-0; P <.001). At Mayo Clinic, more patients had received phenylephrine (56.0% versus 27.0%, P = .009). No differences were found in the postoperative surgical outcomes, and the hospital stay was comparable between the 2 groups. Conclusions: Differences in the preoperative preparation and intraoperative management were associated with differences in intraoperative hemodynamics but not with clinically significant outcomes in patients undergoing laparoscopic adrenalectomy for pheochromocytoma at 2 large tertiary care centers.

AB - 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 <.010) and colloid (median 1000, interquartile range 500-1000, versus median 0, interquartile range 0-0; P <.001). At Mayo Clinic, more patients had received phenylephrine (56.0% versus 27.0%, P = .009). No differences were found in the postoperative surgical outcomes, and the hospital stay was comparable between the 2 groups. Conclusions: Differences in the preoperative preparation and intraoperative management were associated with differences in intraoperative hemodynamics but not with clinically significant outcomes in patients undergoing laparoscopic adrenalectomy for pheochromocytoma at 2 large tertiary care centers.

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