Impact Of Body Composition And Genotype On Hemodynamics During Surgery For Pheochromocytoma And Paraganglioma

Background: Hemodynamic instability(HDI)can increase the risk of cardiovascular accidents and postoperative complications during surgery for pheochromocytoma and paraganglioma(PPGL).However,the underlying factors and mechanisms are not fully elucidated.Based on literature reports and previous studies,body composition and genotype may affect intraoperative hemodynamics in patients with PPGL.Objective: To identify the effects of body composition and genotype on hemodynamics during surgery for PPGL.Methods: A total of 221 patients with PPGL diagnosed and treated in Xiangya Hospital of Central South University from 2010 to 2019 were retrospectively included.We used computed tomography images to assess body composition parameters including skeletal muscle area and visceral fat area.HDI was defined as intraoperative systolic blood pressure > 180 mm Hg and(or)mean arterial pressure < 60 mm Hg.Differences in clinical-genetic characteristics and body composition parameters were analyzed and compared in patients with and without intraoperative HDI,and logistic regression analysis confirmed the risk factors of HDI.Results: 52.9%(117/221)experienced intraoperative HDI.Compared to patients without HDI,patients with HDI had more cluster 2(related to kinase signaling pathways)mutations(59.8% vs.38.5%,P=0.002)and had less sarcopenia(35.9% vs.54.8%,P=0.005).Multivariate analysis showed that urine vanillylmandelic acid(VMA)≥58 μmol/day(adjusted odds ratio [OR]=1.840,95%CI=1.012-3.347,P=0.046),tumor size ≥ 4 cm(adjusted OR=2.278,95%CI=1.242-4.180,P=0.008),and cluster 2 mutations(adjusted OR=2.199,95%CI=1.128-4.285,P=0.021)were independent risk factors for intraoperative HDI,while sarcopenia(adjusted OR=0.475,95%CI=0.266-0.846,P=0.012)decreased the risk.Conclusions: Body composition and genotype can affect hemodynamics during surgery for PPGL.Taking corresponding preventive measures may help to reduce the incidence of perioperative complications.