Abstract Background Preoperative alpha-blockade has long been recommended for pheochromocytoma and paraganglioma surgery. However, recent evidence from high-volume centers questions its benefit. After severe adverse effects in an index case, our hospital discontinued routine alpha-blockade in 2020. Methods We retrospectively analysed all consecutive patients undergoing surgery for pheochromocytoma or paraganglioma between 2018–2024. Data were prospectively collected in the Eurocrine quality registry. Additionally, intraoperative hemodynamics were systematically assessed, including continuous blood pressure curves, heart rate, fluid therapy, and anaesthetic medication use. Results Twenty-one patients underwent surgery (pheochromocytoma n=15, paraganglioma n=6). Five patients (24%) received preoperative alpha-blockade, sixteen (76%) did not. Severe hypertension (180 mmHg) occurred in 60% of patients with alpha-blockade and 56% without. Mean arterial pressure and overall hemodynamic instability scores were comparable between groups. No increase in perioperative complications was observed in the non-blockade cohort. Conclusion In our institution, omission of routine alpha-blockade in pheochromocytoma and paraganglioma patients did not lead to increased hemodynamic instability or perioperative morbidity. Despite limited patient numbers inherent to these rare tumours, our real-world data support the feasibility of surgery without pretreatment in a well-coordinated interdisciplinary setting.
Koch et al. (Fri,) studied this question.