Selective versus non-selective alpha-blockade prior to adrenalectomy for pheochromocytoma - systematic review and meta-analysis.

OBJECTIVE Alpha-adrenergic blockade is currently the first choice of preoperative treatment in patients with functional pheochromocytoma and sympathetic paraganglioma. Nevertheless, there is no consensus whether selective or non-selective alpha-blockade is superior for preventing both perioperative hemodynamic instability and complications. DESIGN Our study aimed to compare selective and non-selective alpha-blockade through a systematic review with meta-analysis. METHODS MEDLINE, Embase, Web of Science and Cochrane Library were searched for eligible studies. Randomized and observational studies comparing selective and non-selective alpha-blockade in pheochromocytoma and sympathetic paraganglioma surgery in adults were included. Data on perioperative hemodynamic parameters and postoperative outcomes were extracted. RESULTS Eleven studies with 1,344 patients were enrolled. Patients receiving selective alpha-blockade had higher maximum intraoperative systolic blood pressure (WMD 12.14 mm Hg, 95% CI 6.06-18.21, p<0.0001) compared to those treated with non-selective alpha-blockade. Additionally, in the group pretreated with selective alpha-blockers, intraoperative vasodilators were used more frequently (OR 2.46, 95% CI 1.44-4.20, p=0.001). Patients treated with selective alpha-blockers had lower minimum intraoperative systolic blood pressure (WMD -2.03 mmHg, 95% CI -4.06 to -0.01, p=0.05) and shorter length of hospital stay (WMD -0.58 days, 95% CI -1.12 to -0.04, p=0.04). Operative time, overall morbidity and mortality did not differ between the groups. CONCLUSIONS This meta-analysis shows non-selective alpha-blockade was more effective in preventing intraoperative blood pressure fluctuations while maintaining comparable risk of both intraoperative and postoperative hypotension and overall morbidity.