The role of adrenal-sparing surgery in the management of aldosterone-producing adenoma: a systematic review and meta-analysis
Authors' conclusion
Our systematic review underscores that LPA for treating APA has similar functional outcomes in terms of biochemical success and clinical response compared with total adrenalectomy, with fewer complications. However, given the observational nature of the currently available studies and the heterogeneity among them in the study population and surgical outcomes definitions, a clinical trial should be conducted to confirm these results.
Study context
- Population
- Patients with PA due to aldosterone-producing adenoma (APA); MEDLINE and Embase searched until May 2024; outcomes per PASO criteria20 studies
- Comparison
- Laparoscopic partial adrenalectomy vs total adrenalectomy
- Outcome
- Functional and surgical outcomes of LPA (pooled)
Pooled result
As reported in the abstract
Pooled biochemical success rate
100%
95% CI 99–100
Pooled clinical response rate (hypertension improvement)
91%
95% CI 48–99
Postoperative complication risk
1%, 95% CI 0-4
Pooled recurrence risk (mean follow-up 25.9 months, range 12-39)
0%
95% CI 0–1
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| LPA vs total adrenalectomy (8 comparative studies)LPAvs Total adrenalectomy | OR, biochemical success 0.80 (95% CI 0.38–1.72) | |
| LPA vs total adrenalectomy (8 comparative studies)LPAvs Total adrenalectomy | OR, clinical cure 1.07 (95% CI 0.77–1.50) | |
| LPA vs total adrenalectomy (8 comparative studies)LPAvs Total adrenalectomy | OR, recurrence 1.57 (95% CI 0.25–9.77) | |
| LPA vs total adrenalectomy (8 comparative studies)LPAvs Total adrenalectomy | OR, need for steroid supplementation 0.96 (95% CI 0.27–3.44) | |
| 0.10.31310Ratio (log scale) |
Laparoscopic partial adrenalectomy (LPA) vs total adrenalectomy (8 comparative studies)
- Rates similar between LPA and total adrenalectomy
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Postoperative complications, LPAvs total adrenalectomy | 0.51 (0.31–0.82) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
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