Preoperative α-blockade versus no blockade for pheochromocytoma-paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis

作者全名："Wang, Jue; Liu, Qingyuan; Jiang, Shihao; Zhang, Jindong; He, Jinke; Li, Yunfan; Wang, Delin"

作者地址："[Wang, Jue; Liu, Qingyuan; Jiang, Shihao; Zhang, Jindong; He, Jinke; Li, Yunfan; Wang, Delin] Chongqing Med Univ, Dept Urol, Affiliated Hosp 1, Chongqing, Peoples R China; [Wang, Jue] Panzhihua Cent Hosp, Dept Urol, Panzhihua, Sichuan, Peoples R China"

通信作者："Wang, DL (通讯作者)，Chongqing Med Univ, Dept Urol, Affiliated Hosp 1, Chongqing 400016, Peoples R China."

来源：INTERNATIONAL JOURNAL OF SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001023362600042

JCR分区：Q1

影响因子：12.5

年份：2023

卷号：109

期号：5

开始页：1470

结束页：1480

文献类型：Review

关键词：alpha-blockade; meta-analysis; paraganglioma; pheochromocytoma

摘要："Background: Surgical resection of pheochromocytomas and paragangliomas (PPGLs) is associated with a significant risk of intraoperative hemodynamic instability and cardiovascular complications. alpha-blockade remains the routine preoperative medical preparation despite controversies over the lack of evidence. We presented an updated meta-analysis to ulteriorly evaluate the potential efficacy of preoperative alpha-blockade versus no blockade for PPGL patients undergoing surgery. Materials and methods: Randomized and nonrandomized comparative studies assessing preoperative alpha-blockade for PPGL surgery in adults were identified through a systematic literature search via MEDLINE, Embase, Web of Science, and CENTRAL up to November 2022. Outcome data of intraoperative hemodynamic parameters and major postoperative events were extracted. Mean difference and risk ratio were synthesized as appropriate for each outcome to determine the cumulative effect size. Results: Fifteen nonrandomized studies involving 3542 patients were finally eligible. Intraoperatively, none of the analyzed hemodynamic parameters differed between patients with or without alpha-blockade: maximum and minimum systolic blood pressure, hypertensive and hypotensive hemodynamic instability episodes, and peak heart rate, subgroup analysis of normotensive PPGL patients yielded similar results with the overall effects. Postoperatively, alpha-blockade was associated with prolonged hypotension and vasopressor usage (risk ratio: 4.21, 95% CI: 1.17-15.18, P = 0.03). ICU admission, length of stay, overall cardiovascular morbidity, and mortality were similar between the two groups. Conclusions: Preoperative alpha-blockade ensured neither more stable intraoperative hemodynamics nor better perioperative outcome over no blockade for PPGL surgery. However, large-volume randomized controlled trials are still warranted to ascertain these findings."

基金机构：Chongqing Municipal Health Commission [2020jstg018]

基金资助正文：This work was supported by grants from the Chongqing Municipal Health Commission (2020jstg018).