Abstract Background Since its introduction in the 60s, preoperative dose-escalation with α-blockade has become a cornerstone for clinical pheochromocytoma management to prevent hemodynamic instability and related complications. However, recent studies have shown shorter hospital stays and less postoperative hypotension in patients undergoing phaeochromocytoma resection without pre-operative dose-escalation of α-blockade. This study aimed to evaluate the impact of both preoperative treatment strategies, α-blockade dose-escalation versus non-escalation, on perioperative outcomes. Method Patients who underwent adrenalectomy for benign or non-metastatic pheochromocytoma at six Dutch tertiary centers from 2015 to 2023 were included. Perioperative outcomes were compared between both pretreatment strategies, including overall complication rate (Clavien-Dindo ≥2) and pheochromocytoma-related morbidity, defined as catecholamine-related cardiovascular complications and postoperative hypoglycemia. Secondary outcomes included postoperative hypotension requiring vasopressor support and length of hospital stay. Results In total, 513 patients were included: 437 followed the preoperative α-adrenergic dose-escalation protocol and 76 the non-escalation protocol. In total, 99 perioperative complications occurred in 65 patients (12.7%), with 1 perioperative death (0.2%). The perioperative complication rate was 12.6% in the dose-escalation group versus 13.2% in the non-escalation group (P=0.890). Pheochromocytoma-related morbidity rate was 6.9% versus 6.6% (P=0.927), respectively. Postoperative hypotension occurred in 54.7% versus 39.5% of patients (P=0.005). Median hospital stay was 10 7-15 versus 3 days 2.1-5.6 (P=0.000). Conclusion Our data suggest that omitting preoperative α-blockade dose-escalation does not compromise perioperative safety and reduces postoperative hypotension and shortens hospital stays. These findings emphasize the need to reevaluate the current standard of preoperative α-blockade dose-escalation.
Holscher et al. (Fri,) studied this question.