Risk Factors For Hemodynamic Instability During Operation In Unilateral Pheochromocytoma And Paraganglioma

Objective The aim is to analyze the factors that lead to hemodynamic nstability during operation in patients with phaeochromocytoma and paraganglioma(PPGLs)and thus improve the perioperative safety.Methods The clinical data of 56 patients with PPGLs treated surgically in Qilu Hospital of Shandong University from January 2015 to September 2020 were analyzed ncluding 25 males and 31 females.Age was from 13 to 72 years old,with mean age of 46.18±13.45 years old.There were 30 cases with left tumor and 26 cases with right tumor.The median volume of tumors was 38.45 cm3(interquartile range:20.93 cm3-97.71 cm3).The median maximum area of cross section was 14.89 cm2(interquartile range:9.26-26.98 cm2),The median level of preoperative fasting glucose was 5.62mmol/L(interquartile range 4.79mmol/L～6.30mmol/L).There were 41 patients underwent laparoscopic surgery and 15 patients underwent open surgery.According to hemodynamic variation during operation,patients were divided into two groups,hemodynamic stability group(HDS,n=35)and hemodynamic instability group(HDI,n=21)According to vasoactive drugs application during operation,patients were divided into two groups,application group(n=29)and non-application group(n=27).Multivariate analysis was used to found independent risk factors for hemodynamic instability and vasoactive drugs application,Receiver operating curve(ROC)were drawn to analyze the area under curve(AUC)with sensitivity and specificity.Results Univariate analysis showed that there were not different in age,BMI,tumor location,the volume of tumor,the median level of preoperative fasting glucose,preoperative HCT and the strategy of operation(P>0.05)between HDI and HDS.There were statistically significant differences between the two groups in gender ratio,average tumor density at the arterial phase with the largest cross section,and tumor heterogeneity(P<0.05).Univariate analysis showed that there were not different in sex,age,BMI,tumor location,the volume of tumor,the median level of preoperative fasting glucose,preoperative HCT and the strategy of operation(P>0.05)between vasoactive drugs application group and non-application group.There were statistically significant differences between the two groups in average tumor density at the arterial phase with the largest cross section,and tumor heterogeneity(P<0.05)between vasoactive drugs application group and non-application group.Multivariate analysis found that male(OR=4.050,P=0.036),low-density enhancement group(≤75Hu)at the arterial phase(OR=5.568,P=0.046),and homogeneity(SD≤26Hu)(OR=5.568,P=0.046)were independent risk factors for hemodynamic instability.Multivariate analysis also found that low-density enhancement group(≤75Hu)at the arterial phase(OR=5.997,P=0.009)were independent risk factors for were independent risk factors for vasoactive drugs application.Conclusions For patients of PPGLs,male,low-density enhancement group(≤75Hu)at the arterial phase,and homogeneity(SD≤26Hu)were independent risk factors for hemodynamic instability during operation.Low-density enhancement group(≤75Hu)at the arterial phase were independent risk factors for vasoactive drugs application.This study can provide help for clinicians to judge the possibility of hemodynamic instability during operation.Then,active preoperative preparation and active communication with anesthesiologists were conducted to ensure perioperative safety of PPGLs patients.However,our results still need to be verified in large-sample,multi-center,prospective clinical study.