Nomogram for predicting hemodynamic instability and the association between preoperative 3D printing and hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma.

Laparoscopic adrenalectomy (LA) for resection of pheochromocytomas (PCCs) is associated with high risk of complications and morbidity due to intraoperative hemodynamic instability (HDI). This study aims to identify factors related to HDI during laparoscopic resection of pheochromocytoma and develop a scoring model for prediction of HDI. Data of a total of 119 patients with pathological confirmed PCCs were collected at a single center in China between 2010 and 2021. All patients underwent unilateral LA for PCCs. Clinical and biochemical variables were collected. Next-generation sequencing was performed in all PCCs patients for detection of mutations. Univariate and multivariable logistic regression analyses were used to select risk factors for constructing the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the nomogram. The calibration curve was performed. Finally, four variables including 24 h urinary output of urine vanillylmandelic acid (VMA) ≥ 58 μmol/day, tumor size ≥ 4 cm, right-side tumor location, Cluster 2 mutations were independent risk factors for HDI during LA and were included in the nomogram. The nomogram demonstrated a good discrimination performance with an AUC of 0.784 [95% confidence interval (CI), 0.701-0.867]. The calibration curve showed a bias-corrected AUC of 0.758. Multivariable analysis revealed that preoperative 3D printing is an independent protective factor for HDI. Our study proposed a novel nomogram for prediction of HDI during LA for resection of PCCs. Preoperative 3D printing was associated with HDI in PCCs.