Analysis Of Preoperative Risk Factors For Hemodynamic Instability During Retroperitoneal Laparoscopic Resection Of Pheochromocytoma

Objective:Laparoscopic resection of pheochromocytoma(LA)is currently the most commonly used surgery for pheochromocytoma,but due to the high incidence of intraoperative hem-odynamic instability(HI)and unpredictability,surgery has become extremely challengin-g.The purpose of this retrospective study was to determine predictors of perioperative HI in patients undergoing unilateral retroperitoneal laparoscopic adrenalectomy for pheo-chromocytoma.Methods:The clinical data of patients with unilateral pheochromocytoma undergoing laparoscopic surgery from 2019 to 2023 in the First Affiliated Hospital of Shanxi Medical University were retrospectively collected.Firstly,HI is defined as the presence of at least one intraoperative SBP>200 mm Hg or at least one intraoperative MAP<60mm Hg.Next,we analyzed and compared the differences in clinical data between patients with intraoperative hemodynamic instability(HI)and patients without HI.We included statistically significant factors into multivariate logistic regression to determine the independent risk factors for the occurrence of intraoperative HI,as well as the relationship between the number of risk factors and the incidence of HI.Results:We included 67 patients with PPGL(median age 48 ± 14.2 years,62% female).Among them,abnormal elevated blood glucose,abnormal systolic blood pressure in the first week before surgery,and tumor diameter>6 cm were independent risk factors for intraoperative HI.The unadjusted incidence of non intraoperative HI in patients with 0,1,2,and 3 risk factors was 0.79,0.48,0.3,and 0.09,respectively.After adjusting for age and other clinical factors,the number of HI risk factors was negatively correlated with the adjusted odds ratio(0.022;95% confidence interval,0.002-0.297)for the incidence of intraoperative HD in individuals with 0 and 3 risk factors.Conclusion:Abnormal elevated blood glucose,tumor size of pheochromocytoma,and abnormal systolic blood pressure in the first week before surgery are independent predictors of hemodynamic stability during retroperitoneal laparoscopic pheochromocytomectomy.Moreover,with the addition of risk factors,the probability of intraoperative HI in patients gradually increases.