7391 Alpha Blockade Practices For Resection Of Pheochromocytoma And Functioning Paraganglioma Differ Between Endocrine And Surgical Teams
Authors: Esteban Mosquera Jorge , Agarwal Shubham , Maxwell Megan , Bryson Trent , Mirfakhraee Sasan , Berry Aiden , Johny Mishal M , Catherine Oltmann Sarah , Mehta Ankeeta , Dackiw Alan P B , Islam Ana , Nwariaku Fiemu , Cadeddu Jeffrey , Woldu Solomon , Jia Liwei , Hamidi Oksana 
Published: October 2024

Abstract
Disclosure: J.E. Mosquera: None. S. Agarwal: None. M. Maxwell: None. T. Bryson: None. S. Mirfakhraee: None. A. Berry: None. M.M. Johny: None. S.C. Oltmann: None. A. Mehta: None. A.P. Dackiw: None. A. Islam: None. F. Nwariaku: None. J. Cadeddu: None. S. Woldu: None. L. Jia: None. O. Hamidi: Advisory Board Member; Self; Corcept Therapeutics.
Background: Surgical tumor resection is the only curative treatment for localized pheochromocytoma and functioning paraganglioma (PPGL). Adequate preoperative preparation with alpha-adrenergic blockers is key before surgical resection. However, differences in practice achieving alpha blockade between medical endocrinology and surgical teams have not been explored. We aim to assess the impact of medical Endocrinology vs Surgical team alpha-blockade practices on intraoperative and post-operative outcomes. Methods: We conducted a retrospective, longitudinal follow-up study of adult patients with histopathologically-proven PPGL. Patients with evidence of metastatic disease, missing anesthesia data, open adrenalectomy, or incomplete surgical resection were excluded from the study. All patients underwent successful curative laparoscopic/robotic surgery between 2006 and 2023 at our institution. We extracted demographic, clinical, laboratory, hemodynamic data, and post-operative outcomes. The difference between these parameters were assessed using descriptive and non-parametric statistics. Preliminary Results: The cohort comprised 62 patients. We extracted preliminary data on 30 patients (57% men): 15 patients prepped by the Endocrinology team and 15 by the Surgical team (Endocrine Surgery and Urology). The mean (SD) age at surgery was 54 yrs (+-13) in the Endocrinology group vs 48 yrs (+-12) in the Surgical group. All cases were pheochromocytoma, except for one case of paraganglioma in the Endocrinology group. Non-selective alpha blockers (phenoxybenzamine) were used in 4 (27%) patients in the Endocrinology group vs 8 (53%) in the Surgical group. Selective alpha-blockers (ie, doxazosin) were used in 11 (73%) patients in the Endocrinology group vs 8 (53%) patients in the Surgical group. The median duration of alpha blockade was 17 days in the Endocrinology group and 24 days in the Surgical group. Five patients in each group were admitted to the intensive care unit with a mean stay of 1.4 days in the Endocrinology group and 1.0 days in the Surgical group. Comparing some of the variables of interest with preliminary data obtained, the only parameter with a statistical difference was the intravenous fluids given, median - 1850 ml vs 2800 ml (p&lt;0.05) in Endocrinology vs Surgical groups, respectively. Conclusions: In patients with PPGL treated with curative laparoscopic resection, the preparation with alpha blockade therapy has some differences between Endocrinology and Surgical groups. Specifically, we observed that Surgical group was more likely to use non-selective alpha blockers and implement longer duration of preoperative alpha blockade. Patients prepped by the Surgical team received more intravenous fluids intraoperatively. Further data collection and analyses are underway to determine if these practices are associated with outcomes.
Presentation: 6/1/2024