MATERIAL AND METHODS
After the approval of the institutional ethic committee, we reviewed the database of 350 patients who underwent single side transperitoneal laparoscopic adrenalectomy in our institution between 2000 and 2020 retrospectively. Patients with a confirmed diagnosis of PHEO by histopathological examination were enrolled in the study and were classified into two groups according to their ages at the date of surgery. Older than 65 years were accepted as elderly.
The clinical, hormonal, and radiologic evaluations were performed for all patients. Surgical indications were decided by consulting to the endocrinologist. The premedications of the patients that referred for surgery were administered according to the recommendations of the endocrinology.
Demographic characteristics of patients such as age, sex, body mass index (BMI), American Society of Anesthesiologists Physical Status Classification System (ASA) score, tumour side, tumour size were compared between groups. The size of the tumours were recorded according to the measurement of pathology reports.
Intraoperative and postoperative outcomes, including duration of anaesthesia, operation time, amount of bleeding, hg reduce, haemodynamic measurements during surgery, complications, duration of hospitalization and anti-hypertensive treatment usage ratios were analyzed between groups. Duration of anaesthesia was accepted as the time (minutes) between the induction of anaesthesia and endotracheal extubation of the patient. Operation time was defined as the time (minutes) between incision and skin closure. The amount of bleeding (ml) was determined by measuring the amount of fluid in the aspirator after surgery. Haemoglobin reduce was determined by measuring the difference in haemoglobin levels between the preoperative and postoperative first days laboratory results.
In this study, we aimed to evaluate hemodynamic instability more accurately, and due to the possibility of the hypertensive episode during endotracheal intubation in PHEO patients, we analyzed the tension and pulse records in the duration of anaesthesia instead of the duration of the operation (9). Additionally, we recorded and analyzed different hemodynamic parameters, including inlet systolic blood pressure (SBP), inlet diastolic blood pressure (DBP), maximum and minimum SBP and DBP and also the systolic and diastolic instabilities. The numbers of episodes of SBP >200 mmHg, SBP > 160mmHg, mean arterial pressure (MAP) <60 mmHg, SBP above 30% the baseline, DBP below 30% the baseline and heart rate (HR) >110 were evaluated. Inlet systolic and diastolic pressures (mmHg) were described as the measurement of the blood pressure before the intubation and administration of the surgical position. Systolic and diastolic instabilities were defined as the differences between maximum and minimum systolic and diastolic blood pressures (mmHg).
Complications were classified according to the Clavien Dindo scoring system and compared between groups. The ratios of using and leaving the anti-hypertensive (HT) treatments in the groups were evaluated.