Abstract
Background
Pheochromocytomas and paragangliomas can induce severe cardiovascular manifestations
such as Takotsubo-like cardiomyopathy. What the perioperative outcomes are of patients
presenting with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy
remains an unresolved question.
Methods
From 2006 to 2019, all patients who underwent surgery for pheochromocytomas/paragangliomas
preceded by Takotsubo-like cardiomyopathy were included from 3 high-volume centers,
with specific attention to perioperative hemodynamic instability and postoperative
outcomes.
Results
Overall, 37 patients were included, with a median age of 45 years. Patients were operated
on 2 months (1–4) after a Takotsubo-like cardiomyopathy episode; 33 (89%) had a laparoscopic
approach. All those who underwent surgery presented in a hemodynamically stable situation.
All except 1 of the pheochromocytomas/paragangliomas patients had at least 1 antihypertensive
treatment at the time of surgery. The median preoperative systolic blood pressure
in the Takotsubo-like cardiomyopathy group was 120 mm Hg (95–132). Overall, 27/34
(79%) of patients required vasoactive drugs during surgery with nicardipine (n = 22), esmolol (n = 12), and/or norepinephrine (n = 8). No patient presented a catecholamine-induced life-threatening complication
such as hypertensive crisis, cardiac arrhythmias, pulmonary edema, cardiac ischemia,
or Takotsubo-like cardiomyopathy in the perioperative period. Severe morbi-mortality
was nil. The systematic review identified 5 studies including 38 pheochromocytomas/paragangliomas
patients with at least 1 episode of acute heart failure considered as Takotsubo-like
cardiomyopathy before surgery, of which 28 patients had delayed surgery with 1 postoperative
death.
Conclusion
Hemodynamically stabilized patients with pheochromocytomas/paragangliomas preceded
by Takotsubo-like cardiomyopathy can be safely scheduled for an elective pheochromocytomas/paragangliomas
surgery, with similar intra and postoperative outcomes as those without Takotsubo-like
cardiomyopathy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Adrenalectomy for incidentaloma: lessons learned from a single-centre series of 274 patients.ANZ J Surg. 2018; 88: 468-473
- Preoperative management of the pheochromocytoma patient.J Clin Endocrinol Metab. 2007; 92: 4069-4079
- Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline.J Clin Endocrinol Metab. 2014; 99: 1915-1942
- Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma.Eur J Endocrinol. 2009; 161: 355-361
- Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.Am Heart J. 2008; 155: 408-417
- Clinical features and outcomes of Takotsubo (stress) cardiomyopathy.N Engl J Med. 2015; 373: 929-938
- Is takotsubo syndrome a microvascular acute coronary syndrome? Towards of a new definition.Eur Heart J. 2016; 37: 2816-2820
- International expert consensus document on Takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology.Eur Heart J. 2018; 39: 2032-2046
- Why the current diagnostic criteria of Takotsubo syndrome are outmoded: a proposal for new criteria.Int J Cardiol. 2014; 174: 468-470
- Pheochromocytoma crisis in the ICU: a french multicenter cohort study with emphasis on rescue extracorporeal membrane oxygenation.Crit Care Med. 2017; 45: e657-e665
- Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis.Herz. 2010; 35: 240-243
- Severity grading of surgical complications.Ann Surg. 2009; 250: 197-198
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaeochromocytoma.Acta Anaesthesiol Scand. 2009; 53: 522-527
- Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma.N Engl J Med. 1992; 327: 1033
- Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy.Br J Surg. 2011; 98: 1392-1399
- Laparoscopic adrenalectomy: the importance of a flank approach in the lateral decubitus position.Surg Endosc. 1994; 8: 135-138
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- Pheochromocytoma revealed by acute heart failure. When should we operate? Presented at the ESES Congress, Gothenburg May 25–26, 2012.Langenbecks Arch Surg. 2013; 398: 729-733
- Pheochromocytoma crisis is not a surgical emergency.J Clin Endocrinol Metab. 2013; 98: 581-591
- Life-threatening events in patients with pheochromocytoma.Eur J Endocrinol. 2015; 173: 757-764
- Takotsubo-like cardiomyopathy in a large cohort of patients with pheochromocytoma and paraganglioma.Endocr Pract. 2017; 23: 1178-1192
- Pheochromocytoma/paraganglioma crisis: case series from a tertiary referral center for pheochromocytomas and paragangliomas.Hormones. 2021; 20: 395-403
- 25 years experience of the surgical treatment of phaeochromocytoma.Eur J Surg. 2002; 168: 716-719
- Laparoscopic adrenalectomy.Br J Surg. 2004; 91: 1259-1274
- Pheochromocytoma: 20years of improving surgical care.Am J Surg. 2019; 217: 967-969
- Point of controversy: perioperative care of patients undergoing pheochromocytoma removal-time for a reappraisal?.Eur J Endocrinol. 2011; 165: 365-373
- Most patients undergoing phaeochromocytoma removal could be safely discharged from the post-anaesthesia care unit to the ward after three hours monitoring.Br J Anaesth. 2018; 120: 879-880
- Inappropriate adrenoreceptor blockade prior to phaeochromocytoma removal is perhaps a “timely reappraisal”.Clin Endocrinol (Oxf). 2016; 85: 989-990
- Dogma is made to be broken. Why are we postponing curative surgery to administer ineffective alpha adrenoreceptor blockade in most patients undergoing pheochromocytoma removal?.Endocr Pract. 2019; 25: 199
- Perioperative alpha-receptor blockade in phaeochromocytoma surgery: an observational case series.Br J Anaesth. 2017; 118: 182-189
- Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension.J Hypertension. 2020; 38: 1443-1456
- Risk factors associated with perioperative complications and prolonged length of stay after laparoscopic adrenalectomy.JAMA Surg. 2018; 153: 1036-1041
- Laparoscopic vs open adrenalectomy for benign adrenal neoplasm.Surg Endosc. 2001; 15: 1356-1358
- Laparoscopic versus open surgery for pheochromocytoma: a meta-analysis.BMC Surg. 2020; 20: 167
- Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma.Surg Endosc. 2008; 22: 1435-1439
- Retrospective comparison of retroperitoneoscopic versus open adrenalectomy for pheochromocytoma.J Urol. 2008; 179 (discussion 60): 57-60
- Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer (Br J Surg. 2004;91:1111–1124).Br J Surg. 2004; 91: 1653-1654
- Maternal and fetal outcomes in phaeochromocytoma and pregnancy: a multicentre retrospective cohort study and systematic review of literature.Lancet Diabetes Endocrinol. 2021; 9: 13-21
Article info
Publication history
Published online: May 16, 2022
Accepted:
April 5,
2022
Footnotes
Elisabeth Hain and Amine Chamakhi should be viewed as first co-authors.
Bertrand Dousset, Laurence Amar, Fabrice Menegaux, and Sébastien Gaujoux should be viewed as last co-authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
