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

Abstract

Background: This systematic review and metanalysis was conducted to assess differences between perioperative and functional outcomes in patients undergoing minimally-invasive partial (mi-PA) and total adrenalectomy (mi-TA) for unilateral primary aldosteronism (uPHA). Material and Methods: Multiple scientific databases (PUBMED, Web of Science, and Cochrane Library) were searched up to November 2021 for surgical series comparing mi-PA vs. mi-TA for uPHA according to the PRISMA statement. Primary outcomes of interest were perioperative and functional outcomes. Results: Overall, a total of 802 patients from six eligible studies were identified, with mi-PA and mi-TA performed in 40.4% (n = 324) and 59.6% (n = 478) of cases, respectively. No differences were recorded between the two groups according to number of transfusions, EBL and Clavien–Dindo complications ≥2. Similarly, no differences in clinical success, persistence of postoperative hypokalemia and improvement in HTN were reported between mi-PA and mi-TA. Conclusions: In a uPHA setting, mi-PA and mi-TA provide comparable perioperative and functional outcomes despite the use of mi-PA remains limited to patients with small adenoma size, or hereditary/bilateral disease. Due to limited use of standardized reporting criteria in most of current series, the quest for a superiority of mi-PA over mi-TA in the treatment of uPHA still remains open.

Clinical cure vs a novel trifecta system for evaluating long-term outcomes of minimally-invasive partial or total adrenalectomy for unilateral primary aldosteronism: results of a multicentric series

“…Furthermore, according to our regression model, surgical technique was neither predictive of complete nor of partial clinical success (each p >0.2). This data further confirmed the feasibility of adrenal sparing surgery in patients affected by unilateral UPA [ 17 ].…”

Clinical Features and Etiology of Recurrent Hypertension after Adrenalectomy

“…The choice of partial and total adrenalectomy remains a controversial topic [17]. In our cohort of patients who developed recurrent elevated blood pressure after adrenalectomy, most (72.1%) underwent partial adrenalectomy; however none of these patients had AVS tests performed before surgery.…”

Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study

“…In a unilateral primary aldosteronism (uPHA) setting, minimally invasive partial adrenalectomy (MIPA) showed excellent perioperative results with a complete clinical success rate of 72.4% ( 24 ). In other study, PA and TA provide comparable perioperative and functional outcomes ( 25 ).Adrenal pathologies are mostly benign, making organ-preserving procedures attractive for many patients ( 6 ).…”