Selective Versus Nonselective Alpha-blockade Prior to Pheochromocytoma Resection - Systematic Review and Meta-analysis

Study Overview
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Brief Summary
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Our aim was to systematically evaluate the current data on the efficacy of pretreatment with either selective or nonselective alpha-blockade on the hemodynamic instability and morbidity during pheochromocytoma resection.

Detailed Description
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RCTs and non-randomized controlled studies comparing preoperative selective alpha-blockade (SAB) with nonselective alpha-blockade (NAB) in pheochromocytoma surgery in adults were eligible for inclusion. All identified articles will be screened by title and abstract. Two independent reviewers will review potentially relevant articles in detail. Dissent will be resolved by consensus and the recommendation of a third observer as required. Data from the included studies will be extracted independently by the two researchers. The Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines will be used for reporting. Quality of Assessment The Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool will be used to assess the quality of included non-randomized studies. The risk of bias of randomized studies will be assessed using the criteria described in the Cochrane Handbook for Systematic Reviews of Interventions .The quality of each study will be assessed by two of the authors. In the event of uncertainties regarding the levels of the studies' quality, a third reviewer will be consulted. Analysis will be performed using RevMan (Version 5.3, freeware from the Cochrane Collaboration). Odds ratios and their associated 95% confidence intervals will be pooled for dichotomous outcomes using the Mantel-Haenszel random-effects method. Continuous outcomes will be pooled as weighted mean difference (WMD) with 95 per cent confidence interval using the inverse-variance random-effects method. WMD and OR will be presented on the graphs as squares, and pooled WMD and OR will be presented as diamond. P ≤ 0.05 will be considered a statistically significant difference for hypothesis and P < 0.10 for heterogeneity testing, respectively. Heterogeneity between the studies will be estimated by statistical tests I2 and Cochran's Q tests.

Official Title
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Selective Versus Nonselective Alpha-blockade Prior to Pheochromocytoma Resection - Systematic Review and Meta-analysis

Conditions
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Pheochromocytoma

Intervention / Treatment
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* Drug: Selective alpha-1-antagonist
* Drug: Non-selective alpha-1-antagonist


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients who received selective or nonselective alpha-blockade prior to pheochromocytoma resection Exclusion Criteria: Patients who did not receive alpha blockade Patients not undergoing surgery No comparison for selective and non-selective pretreatment in the study Studies without primary or sufficient data (reviews, guidelines, meeting abstracts, letters), Studies reported in a language other than English

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| The selective alpha-blockade group<br>Patients treated with selective alpha-blockade before pheochromocytoma surgery | Drug: Selective alpha-1-antagonist<br>* Patients treated with selective alpha-blockade (prazosin, terazosin, doxazosin)<br>|
| The non-selective alpha-blockade group<br>Patients treated with non-selective alpha-blockade before pheochromocytoma surgery | Drug: Non-selective alpha-1-antagonist<br>* Patients treated with non-selective alpha-blockade (phenoxybenzamine)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative maximum systolic blood pressure (mm Hg) |  | intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of systolic blood pressure >160 mmHg |  | intraoperative | 
| Intraoperative maximum diastolic blood pressure (mm Hg) |  | intraoperative | 
| intraoperative maximum heart rate (beats/min) |  | intraoperative | 
| Intraoperative minimum systolic blood pressure (mm Hg) |  | intraoperative | 
| Intraoperative vasopressors administration | (number of patients requiring vasopressors administration) | intraoperative | 
| Intraoperative vasodilators administration | (number of patients requiring vasopressors administration) | intraoperative | 
| Operative time (min) |  | intraoperative | 
| Overall morbidity |  | 30 days | 
| Length of hospital stay (days) |  | Up to 30 days | 
| Postoperative minimum systolic blood pressure (mm Hg) |  | 24 hours | 
| Postoperative vasopressors administration | (number of patients requiring vasopressors administration) | 24 hours | 
| Mortality |  | 30 days | 
| Time of alpha-adrenolytics administration |  | Up to 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pheochromocytoma, surgery, alpha-blockade