Impact of Tumor Arterial Embolization on Hemodynamics During Surgical Resection of Pheochromocytoma and Paraganglioma in Children

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BACKGROUND: Pheochromocytoma and paraganglioma in children present significant intraoperative hemodynamic challenges during surgical resection due to catecholamine release. Preoperative tumor arterial embolization is used to reduce bleeding and stabilize hemodynamics, but its efficacy in pediatric patients remains unclear. METHODS: A retrospective cohort study included 31 children (aged 3-18 years) undergoing resection of pheochromocytoma or paraganglioma at Beijing Children's Hospital from January 2019 to June 2025. Patients were divided into embolization (n = 12) and control (n = 19) groups based on preoperative embolization. High-risk subgroups were defined by tumor diameter ≥ 10 cm or severe catecholamine-related complications. The primary endpoint was intraoperative systolic blood pressure fluctuation amplitude. RESULTS: The embolization group had larger tumors (6.8 ± 3.1 vs. 4.6 ± 1.8 cm, p = 0.038) and more high-risk patients (50% vs. 0%, p = 0.001). Systolic blood pressure fluctuation amplitude was similar between groups (103.9 ± 34.6 vs. 115.2 ± 35.7 mmHg, p = 0.393). No differences were observed in blood loss, time, or area under the curve for systolic blood pressure > 160 mmHg, or intensive care unit stay. Postoperative tumor necrosis was higher in the embolization group (66.7% vs. 10.5%, p = 0.002). One embolization-related stress cardiomyopathy occurred. CONCLUSIONS: Although preoperative tumor arterial embolization did not significantly reduce overall intraoperative blood loss or hemodynamic instability in the entire cohort, it appears to effectively mitigate risk in children with larger, more biochemically active tumors, resulting in outcomes comparable to lower-risk cases managed without embolization. EDITORIAL COMMENT: This article presents single center perioperative experience with preoperative tumor embolization treatments for pediatric pheochromacytoma and paraganglioma cases, and this compared to cases where tumor embolization was not chosen.

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