Management of Patients with Treatment of Pheochromocytoma: A Critical Appraisal
by
, ,
Florence Bihain
1,2, 
Claire Nomine-Criqui
1,
Philippe Guerci
3,
Stephane Gasman
4,
Marc Klein
5 and
Laurent Brunaud
1,2,* 1
Department of Gastrointestinal, Visceral, Metabolic, and Cancer Surgery (CVMC), University Hospital of Nancy (CHRU Nancy), University of Lorraine, Rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
2
Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
3
Department of Anesthesiology and Critical Care Medicine, Institut Lorrain du Coeur Et Des Vaisseaux, University Hospital of Nancy (CHRU Nancy), University of Lorraine, Rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
4
Centre National de la Recherche Scientifique, Institut des Neurosciences Cellulaires et Intégratives, Université de Strasbourg, 67000 Strasbourg, France
5
Department of Endocrinology, Diabetology, and Nutrition (EDN), University Hospital of Nancy (CHRU Nancy), University of Lorraine, Rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
*
Author to whom correspondence should be addressed.
Cancers 2022, 14(16), 3845; https://doi.org/10.3390/cancers14163845
Submission received: 11 July 2022
/
Revised: 27 July 2022
/
Accepted: 4 August 2022
/
Published: 9 August 2022
(This article belongs to the Special Issue Management and Treatment of Endocrine Tumors)
Simple Summary
Preoperative medical preparation with an alpha blockade has been implemented early 1960s to prevent intraoperative hemodynamic instability and consequently decrease morbi-mortality in patients at a high risk of complications. Indeed, surgery at that time consisted of open adrenalectomies with a high morbidity and mortality rate. Current clinical guidelines are based on these early experiences. However, emerging technologies have permitted a drastic reduction of the morbi-mortality rate in patients treated for pheochromocytoma. However, the clinical guidelines have not evolved at the same rate. The aim of this systematic review is to assess the evolution of the management of pheochromocytomas and to appraise the current clinical guidelines to the current clinical practices.
Abstract
The management of pheochromocytomas has significantly evolved these last 50 years, especially with the emergence of new technologies such as laparoscopic procedures in the 1990s. A preoperative blockade using antihypertensive medications to prevent intraoperative hemodynamic instability and cardiocirculatory events is recommended by current clinical guidelines. However, these guidelines are still based on former experiences and are subject to discussion in the scientific community. The aim of this systematic review was to assess the evolution of the management of pheochromocytomas. Laparoscopic procedure is established as the standard of care in current practices. Preoperative medical preparation should be questioned because it does not significantly improve intraoperative events or the risk of postoperative complications in current clinical practice. Current clinical recommendations should be revised and upgraded to current clinical practices.
