The dramatic decline in mortality and morbidity associated with pheochromocytoma surgery over the past decades is frequently attributed to the introduction of perioperative alpha-adrenergic blockade. Therefore, preoperative alpha-blockade is traditionally considered necessary. However, solid evidence (e.g. RCT) for this correlation is lacking. The aim of this national survey was to determine the preferred clinical trial design assessing perioperative care for pheochromocytoma patients.

A survey was sent to specialized physicians involved in pheochromocytoma care in The Netherlands. The survey consisted of questions regarding the current perioperative protocols, patient eligibility, study design and outcome measures.

Twenty-three responses from eleven centres were included. Among the survey respondents, there were 8 (34.8%) endocrine surgeons, 7 (30.4%) endocrinologists, 7 (30.4%) anesthesiologists and 1 (4.3%) nurse-scientist. The preferred study design was a randomized controlled trial with a non-inferiority design comparing full peri-operative alpha blockade versus restricted alpha blockade for treatment of hypertension only. The preferred primary outcome measure was the Hemodynamic Instability Score. Patient selection criteria were more heterogeneous, whereby exclusion of patients at significantly higher risk of developing perioperative complications seemed to be preferred.

Using a qualitative approach, we engaged various specialists involved in the perioperative management of pheochromocytoma patients and provided insight into the preferred design of a future clinical trial that examines perioperative care for patients with pheochromocytoma.