Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Pretreatment with phenoxybenzamine or doxazosin - which better prevents hypertensive surges during laparoscopic adrenalectomy for pheochromocytoma? (#289)

Karolina Zawadzka 1 2 , Piotr Małczak 1 , Michał Wysocki 3 , Piotr Major 1 , Michał Pędziwiatr 1 , Magdalena Pisarska-Adamczyk 4
  1. Jagiellonian University Medical College, 2nd Department of General Surgery, Kraków, Poland
  2. Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Kraków, Poland
  3. Ludwik Rydygier Memorial Specialized Hospital, Department of General Surgery and Surgical Oncology, Kraków, Poland
  4. Jagiellonian University Medical College, Department of Medical Education, Kraków, Poland

Aims: Selective or non-selective alpha-blockers are currently used to prevent intraoperative hypertensive surges during adrenalectomy of pheochromocytomas and paragangliomas (PPGLs). However, the effect of these two types of drugs on the effective prevention of hypertensive surges remains ambiguous. The aim of our study was to compare the effectiveness of pretreatment with phenoxybenzamine (PXB) and doxazosin (DOX) in the context of preventing hypertension during laparoscopic adrenalectomy of phaeochromocytoma.

Methods: From 124 consecutive patients who underwent laparoscopic adrenalectomy of phaeochromocytomas in our clinic between 2003 and 2022, we selected 60 patients pretreated with phenoxybenzamine alone and 30 treated with doxazosin and retrospectively collected their data.

Results: There were no statistically significant differences between the PXB and DOX groups in terms of sex, age, BMI, comorbidities, and pheochromocytoma size. Preoperative systolic blood pressure was higher in doxazosin-treated patients (median 134.5, IQR 20 mm Hg vs median 125, IQR 30 mm Hg in PXB group, p=0.045). There was no difference between groups in diastolic blood pressure before surgery and the first blood pressure measured during surgery. The percentage of patients who experienced hypertension during the procedure did not differ between the PXB and DOX groups: episodes of blood pressure above 160 mmHg in 61.67% vs. 66.67% of patients (p = 0.64), and blood pressure above 200 mm Hg in 23.33% vs. 26.67% of patients (p = 0.73). However, in patients who experienced intraoperative hypertensive episodes, the duration of the BP episodes >200 mmHg was significantly higher in the DOX group: median 7.5 minutes, IQR than in the PXB group (median 7.5, IQR 5 minutes versus median 22.5, IQR 30 minutes, p=0.02).

Conclusion: Patients pretreated with doxazosin had higher systolic blood pressure before surgery. Furthermore, in the doxazosin-treated patients, intraoperative hypertensive episodes above >200 mg lasted significantly longer than in the phenoxybenzamine group.