Safety assessments in the avoidance of preoperative α-receptor blockade in phaeochromocytoma surgery: the pitfalls of a zero numerator

Editor—The recent observational case series reported by Groeben and colleagues¹ addressing the avoidance of preoperative α-receptor blockade in patients undergoing phaeochromocytoma surgery clearly challenges conventional thought. Their study showed that the maximal intraoperative blood pressure in non-α-blocked patients was no different than in those having received preoperative phenoxybenzamine or doxazosin therapy (185 mm Hg vs 178 mm Hg, respectively; P=0.25). In addition, there were no major complications reported – notably an absence of myocardial infarction (MI) – making this practice, at least according to the authors, seemingly "safe". Unfortunately, because of the present study's scope (i.e. an eight yr period of patient accrual) and subject matter, it is unlikely that a confirmatory study will ever be undertaken, so we are left having to rely on the authors' conclusions that "phaeochromocytoma surgery without medical pre-treatment is feasible and safe".

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