Robotic Adrenalectomy and Clevidipine: A New Frontier in Pheochromocytoma Management Preliminary Study

摘要

Background/Objectives: Adrenalectomy for pheochromocytoma presents a risk due to catecholamine discharge, leading to perioperative hemodynamic instability and potential fatality. Recommendations stress surgical caution and care in referral centers. Laparoscopic and robotic adrenalectomy advancements have decreased perioperative risks, with robotic access deemed advantageous for larger tumors. This study aimed to assess if surgical technique and a new clevidipine-based perioperative protocol could improve hemodynamic stability. Methods: All robotic adrenalectomies treated in recent years (50) were included (Group A). A control group of 50 laparoscopic adrenalectomies (Group B) was also included. Results: In Group A, 7 patients had a BMI > 30 (14%), and 20 patients (40%) had pheochromocytomas > 5 cm in size. During surgery, 22 patients (44%) had systolic blood pressure/SBP ≥ 160 mmHg, and 18 patients (36%) had heart rate/HR ≥ 110 bpm. A total of 44 patients (88%) were treated perioperatively with clevidipine, 32 (64%) required amines perioperatively, and 8 (16%) did not require transfer to intensive care. In Group B, 2 patients had BMI > 30 (4%), 12 (24%) had pheochromocytomas > 5 cm in size, 35 (70%) had SBP ≥ 160 mmHg, 16 patients (32%) had HR ≥ 110 bpm, 23 (46%) patients required amines perioperatively, and all were transferred to intensive care after surgery. In addition, 11 (22%) patients were treated with clevidipine. In both groups, MAP < 60 mmHg was equivalent (62% vs. 60%). Conclusions: The clevidipine-based protocol, combined with robotic adrenalectomy, notably for larger tumors, potentially improves perioperative hemodynamic stability, reducing postoperative intensive care needs. This combination could represent an advancement in managing those patients.