• Isabelle Holscher, Anton F Engelsman, DreijerinkKoen M AKMADepartment of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, The Netherlands., Markus W Hollmann, Tijs J van den Berg, and Nieveen van DijkumEls J MEJMDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands..
• Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
• Ann. Surg. 2024 Nov 1; 280 (5): 817824817-824.

ObjectiveThis study describes the effects of introducing a protocol omitting preoperative α-blockade dose-escalation (de-escalation) in a prospective patient group.BackgroundThe decline of mortality and morbidity associated with pheochromocytoma resection is frequently attributed to the introduction of preoperative α-blockade. Current protocols require preoperative α-blockade dose-escalation and multiple-day hospital admissions. However, correlating evidence is lacking. Moreover, recent data suggest equal perioperative safety regardless of preoperative α-blockade escalation.MethodsSingle-institution evaluation of protocol implementation, including patients who underwent adrenalectomy for pheochromocytoma between 2015 and 2023. Intraoperative hemodynamic control was regulated by active adjustment of blood pressure using vasoactive agents. The primary outcome was intraoperative hypertension, defined as the time-weighted average of systolic blood pressure (TWA-SBP) above 200 mm Hg. Secondary outcomes included perioperative hypotension, postoperative blood pressure support requirement, hospital stay duration, and complications.ResultsOf 102 pheochromocytoma patients, 82 were included; 44 in the de-escalated preoperative α-adrenergic protocol and 38 following the previous dose-escalation protocol. Median [IQR] TWA-SBP above 200 mm Hg was 0.01 [0.0-0.4] mm Hg in the de-escalated group versus 0.0 [0.0-0.1] mm Hg in the dose-escalated group ( P =0.073). The median duration of postoperative continuous norepinephrine administration was 0.3 hours [0.0-5.5] versus 5.1 hours [0.0-14.3], respectively ( P =0.003). Postoperative symptomatic hypotension occurred in 34.2% versus 9.1% of patients ( P =0.005). Median hospital stay was 2.5 days [1.9-3.6] versus 7.1 days [6.0-11.9] ( P <0.001). No significant differences in complication rates were observed.ConclusionOur data suggest that adrenalectomy for pheochromocytoma employing a de-escalated preoperative α-blockade protocol is safe and results in a shorter hospital stay.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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