Preoperative Preparation With Selective versus Nonselective Alpha-Adrenoceptor Blockade for Pheochromocytomas and Paragangliomas: A Systematic Review and Updated Meta-Analysis.

OBJECTIVE

Preoperative preparation with nonselective alpha-blockers (NABs) or selective alpha-blockers (SABs) is crucial for the maintenance of intraoperative hemodynamic stability during surgical resection of pheochromocytomas and paragangliomas (PPGLs). This study aims to compare the efficacy and safety of NAB versus SAB for preoperative preparation in patients with PPGL.

METHODS

We systematically searched PubMed, Embase, Web of Science, and Cochrane CENTRAL databases (up to August 2, 2025) for randomized and observational studies directly comparing NAB with SAB. Meta-analyses were performed using a random-effects model.

RESULTS

Twenty studies were included, involving 2293 patients. Not all studies reported every outcome and no single study contributed data to all endpoints. Compared with SAB, NAB significantly reduced the risk of intraoperative hypertensive crisis (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.17 to 0.61, P < .001), the maximum intraoperative systolic blood pressure (mean difference [MD]: -12.85 mmHg, 95% CI: -18.11 to -7.60, P < .001), and the hemodynamic instability score (MD: -6.75, 95% CI: -13.59 to 0.08, P = .05), while maintaining a higher minimum systolic blood pressure (MD: 2.02 mmHg, 95% CI: 0.53 to 3.51, P = .008). Additionally, the intraoperative vasopressors (OR: 0.60, 95% CI: 0.39 to 0.92, P = .02) and vasodilators (OR: 0.50, 95% CI: 0.33 to 0.75, P < .001) were required less frequently in the NAB than SAB group. No significant differences were observed in other secondary outcomes.

CONCLUSION

Preoperative preparation of NAB was superior to SAB in controlling peak intraoperative hypertension and maintaining hemodynamic stability for patients with PPGL.