Preoperative preparation for pheochromocytoma

Once a patient is diagnosed with pheochromocytoma, the patient needs to start medical treatment until she/he is ready for surgical resection. The preoperative medical preparation is often not optimal in clinical practice. Preoperative preparation, however, is critical for an uneventful operation and postoperative recovery.

First of all, pheochromocytoma is not an indication for urgent operation. There is time to prepare the patient for surgical resection of the tumor. For the uninitiated doctors and patients, the diagnosis of pheochromocytoma could elicit a sense of excitement and urgency. They would intuitively imagine that it makes sense to remove the tumor as soon as possible. While pheochromocytoma should be removed as soon as possible, the patient has to be prepared meticulously for the surgery.

The technical part of surgical resection of a pheochromocytoma is not complicated by itself. The tricky part is the patient's "hemodynamic status" during and after operation. "Hemodynamic status" means the patient's hear rate, blood pressure, and quality of the microcirculation inside organs. Pheochromocytoma differs from most other tumors because it produces catecholamines which increase blood pressure and heart rate to dangerous levels. Anesthesia and manipulation of the tumor often release large bouts of catecholamines that dramatically change the patient's "hemodynamic status". Preoperative preparation help prevent these complications and that's why it should be given to all patients.

The preoperative preparation needs to achieve 3 goals: 1) normalization of blood pressure, 2) replenishment of the patient's body fluid, and 3) recovery of heart function. All 3 goals are critically important and all should be met before the operation. Clinically inapparent abnormal heart functions are rather common in patients with pheochromocytoma and these should be reversed as much as possible before the operation.

There are 3 components in the preoperative preparation: 1) blood pressure medications, 2) salty food or intravenous infusion of fluids, and 3) a sufficient duration of the preparation for at least 2 weeks.

Depending on the patient's individual conditions, the doctors may make some adjustment on the regimen of preoperative preparation.

In my own experience, pheochromocytoma resection nowadays is remarkably safe if the patient is carefully prepared before the operation. The same operation can become disastrous if the patient is not carefully prepared. And most importantly, there is no reason why a patient is not carefully prepared. No excuse. Period.

Dr. Pheo