Factors Associated with Complications in Patients with Pheochromocytoma:A Retrospective Analysis_West China Medical Journal

Authors：

 CHENJiao ,  ZUOYun-xia

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZUOYun-xia, Email: 769574913@qq.com

Keywords：

Pheochromocytoma; Complications; Surgery; Prognosis

DOI：

10.7507/1002-0179.20150354

Video：

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Objective To Summarize and analyze the pheochromocytoma complications of surgery patients and its influential factors, in order to provide a basis for preoperative assessment and postoperative support treatment for the patients. Methods We reviewed the clinical data of 88 patients with pheochromocytoma from West China Hospital between January 2010 and December 2012. Among them, 35 had complications (complication group), and the other 53 had no complications (non-complication group). We analyzed preoperative blood catecholamine levels, preoperative preparation, tumor size, tumor location and surgical approach in all these patients. Results There were 16 patients (45.7%) with bilateral adrenal tumors (χ²=19.976, P<0.001), and 9 patients (25.7%) with extra-adrenal tumors (χ²=7.380, P=0.007) in the complication group, significantly higher than 3 (5.7%) and 2 (3.8%) patients respectively in the non-complication group. The diameter of tumor in the complication group was (8.33±3.69) cm, which was significantly higher than that in the non-complication group[(4.32±3.12) cm] (t=5.484, P<0.001). The risk factors for complications in patients undergoing pheochromocytoma surgery included bilateral adrenal tumors (OR=10.316, P<0.001), extraadrenal tumors (OR=8.827, P=0.008), diameter of the tumor longer than 6 cm (OR=94.937, P<0.001), laparotomy (OR=40.727, P<0.001) and long time surgery for more than three hours (OR=312.000, P<0.001). Conclusion Patients who develop complications after pheochromocytoma surgery usually have bigger, and bilateral adrenal or extraadrenal tumors. Patients whose surgery is laparotomy or longer than three hours may also have more complications.These influential factors should be considered in future comprehensive treatment in order to achieve a good prognosis.

Citation： CHENJiao, ZUOYun-xia. Factors Associated with Complications in Patients with Pheochromocytoma:A Retrospective Analysis. West China Medical Journal, 2015, 30(7): 1230-1234. doi: 10.7507/1002-0179.20150354 Copy

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2.	Proye C, Verin P, Sautier M, et al. Pheochromocytome:experiencede 60 interventions[J]. J Urol, 1989, 95(4):285-295.
3.	Pruszczyk P, Januszewicz W, Feltynowski T, et al. Long term followup after surgical removal of pheochromocytoma——observations in 61 patients[J]. Clin Exp Hypertens A, 1991, 13(6/7):1179-1194.
4.	O'riordain DS, Young WF, Grant CS, et al. Clinical spectrum and outcome of functional extraadrenal paraganglioma[J]. World J Surg, 1996, 20(7):916-921.
5.	Orchard T, Grant CS, Van Heerden JA, et al. Pheochromocytoma:continuing evolution of surgical therapy[J]. Surgery, 1993, 114(6):1153-1158.
6.	Favia G, Lumachi F, Polistina F, et al. Pheochromocytoma, a rare cause of hypertension:long-term follow-up of 55 surgically treated patients[J]. World J Surg, 1998, 22(7):689-693.
7.	Xiao XR, Ye LY, Shi LX, et al. Diagnosis and treatment of adrenal tumours:a review of 35 years' experience[J]. Br J Urol, 1998, 82(2):199-205.
8.	Plouin PF, Chatellier G, Fofol I, et al. Tumor recurrence and hypertension persistence after successful pheochromocytoma operation[J]. Hypertension, 1997, 29(5):1133-1139.
9.	Alderazi Y, Yeh MW, Robinson BG, et al. Phaeochromocytoma:current concepts[J]. Med J Aust, 2005, 183(4):201-204.
10.	Ulchaker JC, Goldfarb DA, Bravo EL, et al. Successful outcomes in pheochromocytoma surgery in the modern era[J]. J Urol, 1999, 161(3):764-767.
11.	Lucon AM, Pereira MA, Mendonca BB, et al. Pheochromocytoma:study of 50 cases[J]. J Urol, 1997, 157(4):1208-1212.
12.	Obara T, Kanbe M, Okamoto T, et al. Surgical strategy for pheochromocytoma:emphasis on the pledge of flank extraperitoneal approach in selected patients[J]. Surgery, 1995, 118(6):1083-1089.
13.	Plouin PF, Duclos JM, Menard J, et al. Biochemical tests for diagnosis of phaeochromocytoma:urinary versus plasma determinations[J]. Br Med J (Clin Res Ed), 1981, 282(6267):853-854.
14.	Héron E, Chatellier G, Billaud E, et al. The urinary metanephrineto-creatinine ratio for the diagnosis of pheochromocytoma[J]. Ann Intern Med, 1996, 125(4):300-303.
15.	Rothwell PM, Warlow CP. Is self-audit reliable[J]. Lancet, 1995, 346(7):1623.
16.	Rothwell PM. Interpretation of variations in outcome in audit of clinical interventions[J]. Lancet, 2000, 355(9197):4-5.
17.	Winfield HN, Hamilton BD, Bravo EL, et al. Laparoscopic adrenalectomy:the preferred choice? A comparison to open adrenalectomy[J]. J Urol, 1998, 160(2):325-329.
18.	Bischof T, Günthard H, Straumann E, et al. Splenic infarct, lactate acidosis, and pulmonary edema as manifestations of a pheochromocytoma[J]. Schweiz Med Wochenschr, 1997, 127(7):261-265.
19.	Feng C, Xia SD. A case of pheochromocytoma with secondary dilated cardiomyopathy, ventricular fibrillation and mural thrombus of left ventricle[J]. Int J Cardiol, 2015, 186(18):10-12.
20.	Manger WM. An overview of pheochromocytoma:history, current concepts, vagaries, and diagnostic challenges[J]. Ann N Y Acad Sci, 2006, 1073(1073):1-20.
21.	Young WF, Maddox DE. Spells:in search of a cause[J]. Mayo Clin Proc, 1995, 70(8):757-765.
22.	Işik AC, Erem C, Imamoğlu M, et al. Familial paraganglioma[J]. Eur Arch Otorhinolaryngol, 2006, 263(1):23-31.
23.	Barresi RV, Prinz RA. Laparoscopic adrenalectomy[J]. Arch Surg, 1999, 134(13):212-217.
24.	Siperstein AE, Berber E, Engle KL, et al. Laparoscopicposterior adrenalectomy[J]. Arch Surg, 2000, 135(7):967-971.
25.	Carles J, Guegan H, Crozat T, et al. Spontaneous rupture of the spleen disclosing pheochromocytoma[J]. J Chir (Paris), 1990, 127(10):464-467.

1. Bravo EL. Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma[J]. Endocr Rev, 1994, 15(3):356-368.
2. Proye C, Verin P, Sautier M, et al. Pheochromocytome:experiencede 60 interventions[J]. J Urol, 1989, 95(4):285-295.
3. Pruszczyk P, Januszewicz W, Feltynowski T, et al. Long term followup after surgical removal of pheochromocytoma——observations in 61 patients[J]. Clin Exp Hypertens A, 1991, 13(6/7):1179-1194.
4. O'riordain DS, Young WF, Grant CS, et al. Clinical spectrum and outcome of functional extraadrenal paraganglioma[J]. World J Surg, 1996, 20(7):916-921.
5. Orchard T, Grant CS, Van Heerden JA, et al. Pheochromocytoma:continuing evolution of surgical therapy[J]. Surgery, 1993, 114(6):1153-1158.
6. Favia G, Lumachi F, Polistina F, et al. Pheochromocytoma, a rare cause of hypertension:long-term follow-up of 55 surgically treated patients[J]. World J Surg, 1998, 22(7):689-693.
7. Xiao XR, Ye LY, Shi LX, et al. Diagnosis and treatment of adrenal tumours:a review of 35 years' experience[J]. Br J Urol, 1998, 82(2):199-205.
8. Plouin PF, Chatellier G, Fofol I, et al. Tumor recurrence and hypertension persistence after successful pheochromocytoma operation[J]. Hypertension, 1997, 29(5):1133-1139.
9. Alderazi Y, Yeh MW, Robinson BG, et al. Phaeochromocytoma:current concepts[J]. Med J Aust, 2005, 183(4):201-204.
10. Ulchaker JC, Goldfarb DA, Bravo EL, et al. Successful outcomes in pheochromocytoma surgery in the modern era[J]. J Urol, 1999, 161(3):764-767.
11. Lucon AM, Pereira MA, Mendonca BB, et al. Pheochromocytoma:study of 50 cases[J]. J Urol, 1997, 157(4):1208-1212.
12. Obara T, Kanbe M, Okamoto T, et al. Surgical strategy for pheochromocytoma:emphasis on the pledge of flank extraperitoneal approach in selected patients[J]. Surgery, 1995, 118(6):1083-1089.
13. Plouin PF, Duclos JM, Menard J, et al. Biochemical tests for diagnosis of phaeochromocytoma:urinary versus plasma determinations[J]. Br Med J (Clin Res Ed), 1981, 282(6267):853-854.
14. Héron E, Chatellier G, Billaud E, et al. The urinary metanephrineto-creatinine ratio for the diagnosis of pheochromocytoma[J]. Ann Intern Med, 1996, 125(4):300-303.
15. Rothwell PM, Warlow CP. Is self-audit reliable[J]. Lancet, 1995, 346(7):1623.
16. Rothwell PM. Interpretation of variations in outcome in audit of clinical interventions[J]. Lancet, 2000, 355(9197):4-5.
17. Winfield HN, Hamilton BD, Bravo EL, et al. Laparoscopic adrenalectomy:the preferred choice? A comparison to open adrenalectomy[J]. J Urol, 1998, 160(2):325-329.
18. Bischof T, Günthard H, Straumann E, et al. Splenic infarct, lactate acidosis, and pulmonary edema as manifestations of a pheochromocytoma[J]. Schweiz Med Wochenschr, 1997, 127(7):261-265.
19. Feng C, Xia SD. A case of pheochromocytoma with secondary dilated cardiomyopathy, ventricular fibrillation and mural thrombus of left ventricle[J]. Int J Cardiol, 2015, 186(18):10-12.
20. Manger WM. An overview of pheochromocytoma:history, current concepts, vagaries, and diagnostic challenges[J]. Ann N Y Acad Sci, 2006, 1073(1073):1-20.
21. Young WF, Maddox DE. Spells:in search of a cause[J]. Mayo Clin Proc, 1995, 70(8):757-765.
22. Işik AC, Erem C, Imamoğlu M, et al. Familial paraganglioma[J]. Eur Arch Otorhinolaryngol, 2006, 263(1):23-31.
23. Barresi RV, Prinz RA. Laparoscopic adrenalectomy[J]. Arch Surg, 1999, 134(13):212-217.
24. Siperstein AE, Berber E, Engle KL, et al. Laparoscopicposterior adrenalectomy[J]. Arch Surg, 2000, 135(7):967-971.
25. Carles J, Guegan H, Crozat T, et al. Spontaneous rupture of the spleen disclosing pheochromocytoma[J]. J Chir (Paris), 1990, 127(10):464-467.

West China Medical Journal

Factors Associated with Complications in Patients with Pheochromocytoma:A Retrospective Analysis

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