Perioperative management of paragangliomas and pheochromocytomas

Medwave

卷:20

Magdalena Fermandois¹  Felipe Rojas¹  Cristóbal Román²  Jaime Altamirano³  Iván Pinto³ 

[1] Departamento de Anestesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile;

[2] Departamento de Urología, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile;

[3] Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile;

关键词: neuroendocrine tumors;    perioperative;    pheochromocytoma;    adrenal gland neoplasms;    anesthesia.;   

DOI  :  10.5867/medwave.2020.02.7830

来源: DOAJ

【 摘 要 】

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, characterized by a high morbidity rate due to catecholamine excess. These high levels are independent of physiologic stressors. For the diagnosis, a biochemical workup is paramount. The most widely used are plasma-free metanephrines and urinary fractionated metanephrines. Imaging studies should be initiated once the biochemical diagnosis is established. Evaluation of the patient with pheochromocytomas and paragangliomas must be done taking into account the leading causes of perioperative morbidity and mortality. The two primary interventions that have reduced perioperative mortality are alpha-adrenergic blockade and intravascular volume normalization. Another significant advance has been the establishment of laparoscopic surgery as the gold standard for the surgical approach. No anesthetic technique has been found to be superior to another. Intraoperative hemodynamic instability has been correlated with poorer outcomes; thus one of the main intraoperative goals is maintaining hemodynamic stability. Lower morbidity and almost zero mortality rates due to preoperative and intraoperative management improvements have led to a focus on the immediate and long-term postoperative care. Anual lifelong follow-up is recommended to detect recurrent disease.

【 授权许可】

Unknown