Impact of presurgical beta-blockade on surgical outcomes in patients with PPGLs.

ABSTRACT: The purpose of the study was to analyze the differences in the rate of intraoperative and postsurgical complications in patients with pheochromocytoma and sympathetic paraganglioma (PPGL) based on the use or non-use of preoperative beta-blockade. We performed a retrospective multicenter study of patients who underwent PPGL resection in 23 tertiary hospitals. Patients were classified in two groups according to presurgical treatment with beta-blockade or not. A total of 390 surgical resections of PPGLs were included: 226 in the group of beta-blockade and 164 in the group of no blockade. Beta-blockade was more frequently used in patients with higher fasting plasma glucose and plasma metanephrine levels, and treated with higher doses of phenoxybenzamine and doxazosin. The proportion of patients with proper presurgical blood pressure control was higher in patients pretreated with beta-blockade than non-pretreated (70.7 vs 59.1%, P = 0.027). However, the first group had a higher rate of intraoperative arrhythmia (9.3 vs 3.7%, P = 0.031). Nevertheless, when we adjusted for the daily doses of alpha-blockade, the differences disappeared (adjusted odds ratio (OR) 2.55 (0.83-7.89)). In multivariate analysis, the only variables independently associated with intraoperative arrhythmias were the use of phenoxybenzamine vs doxazosin (OR 8.18 (2.28-29.33)) and a lower preoperative heart rate (OR 0.95 (0.90-0.99)). As a conclusion, presurgical beta-blockade was more commonly used in patients with more active tumors. The higher rate of intraoperative arrhythmia in patients pretreated with beta-blockers seems to be related to the more frequent use of phenoxybenzamine in this group and not directly with the use of beta-blocker.

SIGNIFICANCE STATEMENT: No previous studies have evaluated the impact of presurgical treatment with beta-blockers on patients with pheochromocytomas and sympathetic paragangliomas (PPGLs) receiving alpha-blockade on surgical outcomes, including intraoperative and postsurgical complications. Considering this context, we analyzed the differences in the rate of intraoperative and postsurgical complications in patients with PPGL based on the use or non-use of preoperative beta-blockade. We found that presurgical beta-blockade was more commonly used in patients with more clinically active tumors. The higher rate of intraoperative arrhythmia in patients pretreated with beta-blockers seems to be related to the more frequent use of phenoxybenzamine in this group and not directly with the use of beta-blocker.