Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: Analysis of 165 operations at a singe center

To identify preoperative factors associated with 30-day morbidity and morta lity after pheochromocytoma surgery, we carried out an external review of t he records of all patients undergoing pheochromocytoma surgery from 1975 to 1997 at a single center. One hundred and forty-seven patients, including 2 3 with malignant tumors at the time of the first operation, underwent 165 o perations. Death, resection of a neighboring organ, further surgery, second ary transfer to an intensive care unit, and any events associated with a su rgical stay exceeding 10 days were defined as complications. Mortality and morbidity were 4 of 165 (2.4%) and 38 of 161 (23.6%), respectively. Morbidi ty included 13 spleen resections and hematomas. Spleen complications were n ot related to tumor location, but were probably due to the operative strate gy used, a transperitoneal complete abdominal exploration including both ad renal glands. Complications were independently associated with preoperative systolic blood pressure [odds ratio (OR), 1.14/cm Hg], urinary metanephrin e excretion(OR, 1.18/10 mu mol.day), and with the number of operations (rep eat us. first operation OR, 5.36). In conclusion, pheochromocytoma resectio n consistently involves a risk of complications. Spleen damage should be pr evented by complete preoperative localization studies and an elective or la paroscopic surgical approach. Careful blood pressure control should help pr event complications. Patients with high secretion tumors and those undergoi ng repeat intervention are at high risk of complications and should be refe rred to centers familiar with pheochromocytoma management.