Objectives: Surgery of pheochromocytomas (PCs) still carries a high risk of hemodynamic complications during the perioperative period. We aimed to evaluate the influence of their secretory phenotype and preoperative alpha-blocker treatment on surgical outcome.
Design: a retrospective monocentric study at a tertiary medical centre.
Patients: 80 consecutive patients operated by the same team for a PC between 1988 and 2018.
Results: Diagnosis was based on typical symptoms and signs in 58 patients, genetic testing in 12 and work-up of an adrenal incidentaloma in 9. It was made during surgery in one patient. A genetic predisposition was found in one third of index cases (21/62). The majority of the patients (73/79) had a secreting PC; more than 2/3 had an adrenergic phenotype and less than 1/3 a noradrenergic phenotype. The rate of perioperative hemodynamic complications was not influenced by the secretory phenotype, but persistent hypertension after surgery, recurrence and malignancy were more frequently observed in patients with a noradrenergic tumour. Preoperative alpha-blocker treatment was given for ≥ 14 days in 29 patients and, although being more symptomatic at diagnosis, these patients had less hemodynamic complications (3/29 vs. 12/51 non-treated patients, p=0.05).
Conclusions: The occurrence of hemodynamic complications during surgery was not significantly affected by the secretory phenotype in our study, but noradrenergic tumours show a worse post-surgical outcome. Our data also provide additional support in favor of a sufficient preoperative alpha-blockade in patients with pheochromocytoma.