Effect of x-ray endovascular electrocoagulation occlusion of the adrenal vessels on perioperative hemodynamic changes in patients, who undergo laparoscopic adrenalectomy due to pheochromocytoma and other adrenal tumors

Abstract

The aim. Evaluate and compare perioperative hemodynamic changes in patients with pheochromocytoma, who have undergone laparoscopic adrenalectomy with Х-ray endovascular electrocoagulation occlusion of the adrenal vessels, with patients, who have undergone LA due to another adrenal tumors in the same period of time. Material and methods. To evaluate the effectiveness of the multidisciplinary approach provided an analysis of treatment of 81 patients with adrenal tumors for the period from 2008 to 2019 was conducted. In the aim of comparative analysis, two groups were formed: I group includes 37 patients with adrenal pheochromocytoma, who had undergone adrenal vessels occlusion 24 hours before the LA, and group II (for comparison) — 44 patients — who underwent LA for other adrenal tumors. Patients with pheochromocytoma also received α-blockers (doxazosin) for two weeks as preparations for surgery. Groups of patients were compared according to hemodynamic parameters, duration of surgical intervention, tumor size, volume of intraoperative blood loss and frequency of complications. Results. There were no significant difference between the patients of both groups by

the age, sex, tumor localization and tumor size. The duration of the EVECO of the adrenal vessels was in the range of 20-30 minutes. Were observed no severe complications during the  implementation of the EVECO. To evaluate hemodynamic parameters, SBP and heart rate were studied both at the point of adrenal gland mobilization and after CAV ligation. At the point of adrenal tumor mobilization during LA, SBP level in patients from the second group was 145.2±22.1 mm Hg. With heart rate 79.7±14.9 beats/min. Accordingly, in the I group, the SBP level was130.6 ± 9.2 mm Hg, and the heart rate 70.8±9.7 beats/min. Thus, the average levels of SBP and HR in group I were significantly lower than in group II (p=0.00188 and 0.0096, respectively). After CAV ligation, patients from the second group had significant SBP decreasing, on average up to 123.5±15.4 mm Hg. Patients from the first group, had no SBP decreasing after CAV ligation. Operation time in patients from the second group was significantly higher than in the first group (138.7±48.1 min vs. 105.0±41.5 min, p=0.00001). The average blood loss volume in group І was significantly lower (51.6±12.1 ml versus 165.2±75.9 ml, p=0.00001). In postoperative period, complications were observed in 2 (4.5%) group ІІ patients and in 1 (2.7%) group І patient. There were no fatal cases in both groups. Conclusions. Using of Х-ray EVECO of the adrenal vessels as a part of the complex surgical treatment of pheochromocytoma is a perspective approach for prevention intraoperative hemodynamic disorders and bleeding.