Guo Nan, Liu Tao, Zhao Ping, Bai Song
Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Urology, The First Hospital of China Medical University, Shenyang, China.
Clin Endocrinol (Oxf). 2025 Mar;102(3):273-280. doi: 10.1111/cen.15181. Epub 2024 Dec 18.
The effects of pheochromocytomas and paragangliomas (PPGLs)-induced catecholamine overproduction on vascular and cardiac function are generally thought to be reversible after PPGLs removal. However, a sizable proportion of patients who were free of the recurrent disease still faced high risks of cardiovascular problems after successful surgery. We aim to identify incidence and risk factors for long-term cardiovascular complications in PPGLs patients after surgery.
We retrospectively reviewed 602 patients who underwent surgery for sporadic PPGLs at three centers between January 2012 and October 2022. Demographic characteristics and perioperative data were recorded. Multiple logistic regression was used to determine the risk factors for postoperative long-term cardiovascular complications.
Finally, a total of 602 patients were included in the analysis, comprising 460 (76.4%) patients with pheochromocytomas and 142 (23.6%) patients with paragangliomas. After a median follow-up of 64 months, 76 (12.6%) patients had developed long-term cardiovascular complications. Independent risk factors included pheochromocytomas (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.425-11.965, p = 0.009), had low preoperative left ventricular ejection fraction (LVEF, OR = 5.659, 95% CI: 2.141-14.955, p < 0.001), experienced intraoperative hemodynamic instability (HDI, OR = 2.498, 95% CI: 1.423-4.385, p = 0.001), suffered from postoperative in-hospital cardiovascular complications (OR = 5.723, 95% CI: 2.078-15.758, p = 0.001) and long-term persistent hypertension (OR = 3.552, 95% CI: 1.580-7.988, p = 0.002).
Long-term cardiovascular complications commonly occur in patients with surgical-cured PPGLs. Pheochromocytomas, had low preoperative LVEF, experienced intraoperative HDI, suffered from postoperative in-hospital cardiovascular complications, and persistent hypertension were determined as the risk factors for long-term cardiovascular complications. These findings may help to improve follow-up management.
嗜铬细胞瘤和副神经节瘤（PPGLs）引起的儿茶酚胺过量产生对血管和心脏功能的影响通常被认为在切除PPGLs后是可逆的。然而，相当一部分无复发疾病的患者在手术成功后仍面临心血管问题的高风险。我们旨在确定PPGLs患者术后长期心血管并发症的发生率和危险因素。
我们回顾性分析了2012年1月至2022年10月期间在三个中心接受散发性PPGLs手术的602例患者。记录人口统计学特征和围手术期数据。采用多因素logistic回归分析确定术后长期心血管并发症的危险因素。
最终，共有602例患者纳入分析，其中嗜铬细胞瘤患者460例（76.4%），副神经节瘤患者142例（23.6%）。中位随访64个月后，76例（12.6%）患者出现长期心血管并发症。独立危险因素包括嗜铬细胞瘤（比值比[OR]=4.13，95%置信区间[CI]：1.425-11.965，p=0.009）、术前左心室射血分数（LVEF）低（OR=5.659，95%CI：2.141-14.955，p<0.001）、术中血流动力学不稳定（HDI，OR=2.498，95%CI：1.423-4.385，p=0.001）、术后住院期间发生心血管并发症（OR=5.723，95%CI：2.078-15.758，p=0.001）和长期持续性高血压（OR=3.552，95%CI：1.580-7.988，p=0.002）。
手术治愈的PPGLs患者常发生长期心血管并发症。嗜铬细胞瘤、术前LVEF低、术中出现HDI、术后住院期间发生心血管并发症以及持续性高血压被确定为长期心血管并发症的危险因素。这些发现可能有助于改善随访管理。
