OC7.5 - ECE_3450 - Intraoperative hypotension versus hypertension in patients with pheochromocytoma and paraganglioma: a multicenter Chinese study of 998 cases

Abstract Background Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors characterized by excessive catecholamine production, which predisposes patients to intraoperative hypertensive crises (IHC) and/or hypotension (IOH). This study aims to investigate the perioperative characteristics and identify risk factors associated with different hemodynamic profiles during PPGL surgery. Methods We conducted a retrospective analysis of patients with pathologically confirmed PPGL who underwent surgical resection between January 2010 and December 2024 across four tertiary medical centers in China. Data collected included demographic, clinical, tumor-related, genetic, and perioperative variables. IOH was defined as mean arterial pressure (MAP) <65 mmHg, and IHC as systolic blood pressure ≥180 mmHg. Patients were stratified into four hemodynamic groups: no IOH/IHC, IHC only, IOH only, and both IOH/IHC. Multivariable logistic regression was employed to identify independent predictors for each hemodynamic category. Results Among the 998 patients analyzed, 324 had no IOH/IHC, 306 had IHC only, 181 had IOH only, and 187 experienced both IOH and IHC. Postoperative intensive care unit (ICU) admission was highest in the combined IOH/IHC group (56.5%, 105/186), compared to the IOH-only (38.7%, 70/181), IHC-only (24.3%, 74/305), and no-instability groups (17.6%, 57/324). In multivariable analysis, older age (OR 4.931, 95% CI 1.523-15.965), presence of pre-surgical hypertension (OR 0.554, 95% CI 0.366-0.839), and preoperative α-blocker use (OR 2.006, 95% CI 1.225-3.487) were independent predictors of IOH only. Laparoscopic surgery (OR 1.483, 95% CI 1.001-2.197) and kinase-signaling pathway gene variants (OR 2.561, 95% CI 1.749-3.751) were predictors of IHC only. For combined IOH/IHC, independent predictors included older age (OR 5.319, 95% CI 2.077-13.623), tumor diameter ≤4.05 cm (OR 0.513, 95% CI 0.339-0.777), and kinase-signaling gene variants (OR 2.681, 95% CI 1.701-4.224). Conclusions Patients with PPGL exhibit distinct hemodynamic profiles during surgery, each associated with specific risk factors. Perioperative strategies—including surgical approach selection and α-blocker administration—should be tailored based on age, tumor size, pre-surgical hypertension, and genetic background to optimize intraoperative hemodynamic stability.