Selective versus non-selective alpha-blockade prior to adrenalectomy for pheochromocytoma – systematic review and meta-analysis

in European Journal of Endocrinology
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  • 1 K Zawadzka, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 2 K Więckowski, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 3 P Małczak, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 4 M Wysocki, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 5 P Major, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 6 M Pędziwiatr, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 7 M Pisarska-Adamczyk, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, 31-008, Poland

Correspondence: Magdalena Pisarska-Adamczyk, Email: magdalenapisarska@interia.pl
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Objective: Alpha-adrenergic blockade is currently the first choice of preoperative treatment in patients with functional pheochromocytoma and sympathetic paraganglioma. Nevertheless, there is no consensus whether selective or non-selective alpha-blockade is superior for preventing both perioperative hemodynamic instability and complications.

Design: Our study aimed to compare selective and non-selective alpha-blockade through a systematic review with meta-analysis.

Methods: MEDLINE, Embase, Web of Science and Cochrane Library were searched for eligible studies. Randomized and observational studies comparing selective and non-selective alpha-blockade in pheochromocytoma and sympathetic paraganglioma surgery in adults were included. Data on perioperative hemodynamic parameters and postoperative outcomes were extracted.

Results: Eleven studies with 1,344 patients were enrolled. Patients receiving selective alpha-blockade had higher maximum intraoperative systolic blood pressure (WMD 12.14 mm Hg, 95% CI 6.06-18.21, p<0.0001) compared to those treated with non-selective alpha-blockade. Additionally, in the group pretreated with selective alpha-blockers, intraoperative vasodilators were used more frequently (OR 2.46, 95% CI 1.44-4.20, p=0.001). Patients treated with selective alpha-blockers had lower minimum intraoperative systolic blood pressure (WMD -2.03 mmHg, 95% CI -4.06 to -0.01, p=0.05) and shorter length of hospital stay (WMD -0.58 days, 95% CI -1.12 to -0.04, p=0.04). Operative time, overall morbidity and mortality did not differ between the groups.

Conclusions: This meta-analysis shows non-selective alpha-blockade was more effective in preventing intraoperative blood pressure fluctuations while maintaining comparable risk of both intraoperative and postoperative hypotension and overall morbidity.

 

     European Society of Endocrinology

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