Side-specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study.

Autor: Habeeb TAAM; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt. tameralnaimy@hotmail.com., Araujo-Castro M; Neuroendocrinology & Adrenal Unit of the Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain., Chiaretti M; Department of General Surgery Specialties and Organ Transplant, Faculty of Pharmacy and Medicine, Sapienza Rome University, Rome, Italy., Podda M; Department of Surgical Science, University of Cagliari, Cagliari, Italy., Aiolfi A; Department of Biomedical Sciences for Health, Milan, Italy., Kryvoruchko IA; Surgery Department #2, Kharkiv National Medical University, Kharkiv, Ukraine., Manangi MN; Department of General Surgery, Bangalore Medical College and Research Institute, Bengaluru, India., Shelat V; General Surgery, Tan Tock Seng Hospital, Singapore, Singapore., Kalmoush AE; General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt., Labib MF; General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt., Elshafey MH; General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt., Ibrahim SMM; Lieutenant Colonel Doctor, Armed Forces College of Medicine, Cairo, Egypt., Abo Alsaad MI; General Surgery Department-Faculty of Medicine, Merit University, Sohag, Egypt., Elbelkasi H; Mataryia Teaching Hospital, GOTHI, Cairo, Egypt., Mansour MI; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Elshahidy TM; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Heggy IA; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Elsayed RS; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Fiad AA; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Yehia AM; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Yassin MA; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Elballat MR; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Hebeishy MH; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., AboZeid AK; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Saleh MAA; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Hamed AEM; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Abdelghani AA; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Mousa B; Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Aug; Vol. 38 (8), pp. 4571-4582. Date of Electronic Publication: 2024 Jul 01.
DOI: 10.1007/s00464-024-10974-w
Abstrakt: Background: Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA).
Methods: We retrospectively analyzed two hundred and seventy-one patients aged > 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included.
Results: Intraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p < 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147-27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996-30.38, p < 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323-47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07-1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other.
Conclusion: LRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI.
(© 2024. The Author(s).)
Databáze: MEDLINE
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