MATERIAL AND METHODS
After the approval of the institutional ethic committee, we reviewed the
database of 350 patients who underwent single side transperitoneal
laparoscopic adrenalectomy in our institution between 2000 and 2020
retrospectively. Patients with a confirmed diagnosis of PHEO by
histopathological examination were enrolled in the study and were
classified into two groups according to their ages at the date of
surgery. Older than 65 years were accepted as elderly.
The clinical, hormonal, and radiologic evaluations were performed for
all patients. Surgical indications were decided by consulting to the
endocrinologist. The premedications of the patients that referred for
surgery were administered according to the recommendations of the
endocrinology.
Demographic characteristics of patients such as age, sex, body mass
index (BMI), American Society of Anesthesiologists Physical Status
Classification System (ASA) score, tumour side, tumour size were
compared between groups. The size of the tumours were recorded according
to the measurement of pathology reports.
Intraoperative and postoperative outcomes, including duration of
anaesthesia, operation time, amount of bleeding, hg reduce, haemodynamic
measurements during surgery, complications, duration of hospitalization
and anti-hypertensive treatment usage ratios were analyzed between
groups. Duration of anaesthesia was accepted as the time (minutes)
between the induction of anaesthesia and endotracheal extubation of the
patient. Operation time was defined as the time (minutes) between
incision and skin closure. The amount of bleeding (ml) was determined by
measuring the amount of fluid in the aspirator after surgery.
Haemoglobin reduce was determined by measuring the difference in
haemoglobin levels between the preoperative and postoperative first days
laboratory results.
In this study, we aimed to evaluate hemodynamic instability more
accurately, and due to the possibility of the hypertensive episode
during endotracheal intubation in PHEO patients, we analyzed the tension
and pulse records in the duration of anaesthesia instead of the duration
of the operation (9). Additionally, we recorded and analyzed different
hemodynamic parameters, including inlet systolic blood pressure (SBP),
inlet diastolic blood pressure (DBP), maximum and minimum SBP and DBP
and also the systolic and diastolic instabilities. The numbers of
episodes of SBP >200 mmHg, SBP > 160mmHg, mean
arterial pressure (MAP) <60 mmHg, SBP above 30% the baseline,
DBP below 30% the baseline and heart rate (HR) >110 were
evaluated. Inlet systolic and diastolic pressures (mmHg) were described
as the measurement of the blood pressure before the intubation and
administration of the surgical position. Systolic and diastolic
instabilities were defined as the differences between maximum and
minimum systolic and diastolic blood pressures (mmHg).
Complications were classified according to the Clavien Dindo scoring
system and compared between groups. The ratios of using and leaving the
anti-hypertensive (HT) treatments in the groups were evaluated.