Minimally invasive partial versus total adrenalectomy for unilateral primary hyperaldosteronism-a retrospective, multicenter matched-pair analysis using the new international consensus on outcome measures

Minimally Invasive Partial vs. Total Adrenalectomy for the Treatment of Unilateral Primary Aldosteronism: A Systematic Review and Meta-Analysis

“…A major advantage of mi-PA over mi-TA may be represented by the decreased incidence of postoperative hypocortisolism. An increased rate of postoperative subclinical transient hypocortisolism after mi-TA was reported by Billman et al (25.0% vs. 11.5% after mi-TA and mi-PA, respectively; p < 0.001) [ 36 ]. However, none of these patients needed permanent steroid replacement at median follow up of 24 months.…”

“…Finally, Waltz et al reported their experience on minimally-invasive adrenalectomy for PHA, without providing a comparison between PA vs. TA [ 14 ]. Conversely, among eligible studies, we identified only one randomized controlled trial (level of evidence 1b) [ 34 ]; one prospective non-randomized study (level of evidence: 2b) [ 35 ]; and four retrospective studies (level of evidence: 3b [ 10 , 11 , 36 ] or 4 [ 37 ]), respectively.…”

“…According to PASO criteria, complete, partial, and absent clinical success analyzed over 324 patients from two series showed no differences [ 10 , 36 ]. Moreover, similar results were found when considering no-standardized complete and absent clinical success over five studies for a total of 720 patients included [ 10 , 11 , 34 , 35 , 36 ]. No differences in persistence of postoperative hypokalemia and improvement in HTN were reported between mi-PA and mi-TA.…”

“…Conversely, a higher steroid replacement rate was reported by Anceschi et al, when compared mi-TA vs. mi-PA [ 10 ]. To date, available data suggest a negligible incidence of long-term steroid replacement after unilateral adrenalectomy for uPHA, irrespectively of the surgical approach (3–4.5%) [ 36 ].…”

“…Nonetheless, Vorselaars et al claimed that the use of high thresholds for definition of clinically relevant change in SBP, as well as the use of percentage, instead of absolute values, for evaluating daily-defined dose of medical treatment, represent the main drawbacks of these criteria [ 41 ]. To the best of our knowledge, only two published studies reported the comparison of clinical success between mi-PA and mi-TA according to PASO criteria [ 10 , 36 ]. We recorded comparable rate of complete, partial and absent clinical success between mi-PA and mi-TA according to PASO criteria (each p > 0.05).…”