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Meta-Analysis
. 2023 May 1;109(5):1470-1480.
doi: 10.1097/JS9.0000000000000390.

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

Jue Wang  1   2 , Qingyuan Liu  1 , Shihao Jiang  1 , Jindong Zhang  1 , Jinke He  1 , Yunfan Li  1 , Delin Wang  1
Affiliations
Meta-Analysis

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

Jue Wang et al. Int J Surg. .

Abstract

Background: Surgical resection of pheochromocytomas and paragangliomas (PPGLs) is associated with a significant risk of intraoperative hemodynamic instability and cardiovascular complications. α-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 α-blockade versus no blockade for PPGL patients undergoing surgery.

Materials and methods: Randomized and nonrandomized comparative studies assessing preoperative α-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 α-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, α-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 α-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.

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Conflict of interest statement

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plot of intraoperative maximum systolic blood pressure comparing α-blockade with no blockade. PPGL, pheochromocytoma and paraganglioma.
Figure 3
Figure 3
Forest plot of intraoperative minimum systolic blood pressure comparing α-blockade with no blockade. PPGL, pheochromocytoma and paraganglioma.
Figure 4
Figure 4
Forest plot of intraoperative hypertensive hemodynamic instability episode comparing α-blockade with no blockade.
Figure 5
Figure 5
Forest plot of intraoperative hypotensive hemodynamic instability episode comparing α-blockade with no blockade.
Figure 6
Figure 6
Forest plot of intraoperative highest heart rate comparing α-blockade with no blockade. PPGL, pheochromocytoma and paraganglioma.
Figure 7
Figure 7
Forest plot of major postoperative events comparing α-blockade with no blockade. ICU admission (A), vasopressor usage (B), length of stay (C), and overall cardiovascular morbidity (D).
Figure 8
Figure 8
Sensitivity analysis of effect estimates. Minimum systolic blood pressure (A) and length of stay (B).
See this image and copyright information in PMC

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