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Multicenter Study
. 2025 Mar;32(3):1709-1720.
doi: 10.1245/s10434-024-16591-0. Epub 2024 Dec 4.

Outcomes for Patients with Obesity Undergoing Adrenalectomy for Pheochromocytoma: An International Multicenter Analysis

Kevin Verhoeff #  1 , Alessandro Parente #  2   3   4 , Yanbo Wang  5 , Nanya Wang  6 , Zhicheng Wang  5 , Maciej Śledziński  7 , Andrzej Hellmann  7 , Marco Raffaelli  8 , Francesco Pennestrì  8 , Mark Sywak  9 , Alexander J Papachristos  9 , Fausto F Palazzo  10 , Tae-Yon Sung  11 , Byung-Chang Kim  11 , Yu-Mi Lee  11 , Fiona Eatock  12 , Hannah Anderson  12 , Maurizio Iacobone  13 , Albertas Daukša  14 , Ozer Makay  15 , Yigit Turk  16 , Hafize Basut Atalay  16 , Els J M Nieveen van Dijkum  17 , Anton F Engelsman  17 , Isabelle Holscher  17 , Gabriele Materazzi  18 , Leonardo Rossi  18 , Chiara Becucci  18 , Susannah L Shore  19 , Clare Fung  19 , Alison Waghorn  19 , Radu Mihai  20 , Sabapathy P Balasubramanian  21 , Arslan Pannu  21 , Shuichi Tatarano  22 , David Velázquez-Fernández  23 , Julie A Miller  24 , Hazel Serrao-Brown  9 , Yufei Chen  25 , Marco Stefano Demarchi  26 , Reza Djafarrian  26 , Helen Doran  27 , Kelvin Wang  27 , Michael J Stechman  28 , Helen Perry  28 , Johnathan Hubbard  29 , Cristina Lamas  30 , Philippa Mercer  31 , Janet MacPherson  32 , Supanut Lumbiganon  33 , María Calatayud  34 , Felicia Alexandra Hanzu  35 , Oscar Vidal  36 , Marta Araujo-Castro  37 , Cesar Minguez Ojeda  38 , Theodosios Papavramidis  39 , Pablo Rodríguez de Vera Gómez  40 , Abdulaziz Aldrees  41 , Tariq Altwjry  41 , Nuria Valdés  42 , Cristina Álvarez-Escola  43 , Iñigo García Sanz  44 , Concepción Blanco Carrera  45 , Laura Manjón-Miguélez  46   47 , Paz De Miguel Novoa  48 , Mónica Recasens  49 , Rogelio García Centeno  50 , Cristina Robles Lázaro  51 , Klaas Van Den Heede  52 , Sam Van Slycke  52 , Theodora Michalopoulou  53 , Sebastian Aspinall  54 , Ross Melvin  54 , Joel Wen Liang Lau  55 , Wei Keat Cheah  55 , Man Hon Tang  55 , Han Boon Oh  55 , John Ayuk  56 , Robert P Sutcliffe  57 ; International Pheo Study Group
Affiliations
Multicenter Study

Outcomes for Patients with Obesity Undergoing Adrenalectomy for Pheochromocytoma: An International Multicenter Analysis

Kevin Verhoeff et al. Ann Surg Oncol. 2025 Mar.

Abstract

Objective: The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications.

Patients and methods: Obese (body mass index (BMI) ≥ 30 kg/m2) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI).

Results: Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m2 was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35).

Conclusions: Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings.

Keywords: Laparoscopic adrenalectomy; Obesity; Pheochromocytoma; Postoperative complications; Robotic adrenalectomy.

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Conflict of interest statement

Disclosure: The authors declare no conflicts of interest. Ethical approval: The study was approved with registration: CARMS-18769.

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