Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: The role of pathology

Trésallet, Christophe; Salepcioglu, Harika; Godiris-Petit, G.; Hoang, Catherine; Girerd, Xavier; Ménégaux, Fabrice

doi:10.1016/j.surg.2009.11.020

Cited by 33 publications

(27 citation statements)

References 21 publications

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“…On the contrary, according to our results, Shen et al [20] in a 13-year review of 456 cases, have shown that the size of the tumor is the most important prediction factor for complications and conversion to laparotomy. Concerning the age and BMI, our data are in agreement with most of the authors, who reported a significantly older age and increased BMI in the case of complicated laparoscopic adrenalectomy [21].…”

Section: Discussionsupporting

confidence: 92%

Complications in laparoscopic adrenalectomy: the value of experience

et al. 2011

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The main risk factors for the occurrence of complications during laparoscopic adrenalectomy appear to be surgical inexperience, age, and body mass index of the patient, the dimension of the mass, and pheochromocytoma. Therefore, laparoscopic adrenalectomy, especially for tumors that are potentially more complicated, should only be undertaken in high-volume specialist centers by surgeons with the appropriate training and experience.

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Section: Discussionsupporting

confidence: 92%

Complications in laparoscopic adrenalectomy: the value of experience

et al. 2011

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“…Clinical outcomes of patients with histological evidence of hyperplasia are virtually identical to those in patients with evidence of adenoma. This fact is consistent with studies that consider unilateral adrenal hyperplasia as far more frequent than previously thought [26][27][28][29][30] . In recent years, new histological forms causing unilateral aldosterone hypersecretion (nodular adrenal hyperplasia, unilateral multiple adrenocortical mikronodules, primary unilateral hyperplasia) have been described 9,26,27,30,31 .…”

Section: Discussionsupporting

confidence: 92%

Outcomes of adrenalectomy in patients with primary hyperaldosteronism - a single centre experience

Hartmann¹,

Grepl²,

Vidlář³

et al. 2014

BIOMED PAP

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Introduction. Primary hyperaldosteronism is a common cause of secondary hypertension. In patients with proven unilateral overproduction of aldosterone adrenalectomy can cure hyperaldosteronism with high probability and a positive effect on hypertension. The aim of the study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters. The secondary objective was to identify parameters that would allow the prediction of hypertension cure. Methods. We performed a cross-sectional analysis of the data of patients who underwent unilateral adrenalectomy for primary aldosteronism at the Department of Urology of University Hospital Olomouc in the years 2000-2011. We assesed the preoperative clinical conditions of patients, the results of biochemical and radiological examinations, course of the surgery and post-operative course including laboratory and clinical parameters during the 12 months postoperatively. Results. 62 patients underwent adrenalectomy for primary aldosteronism in this period. Four patients were excluded from the study due to surprising histology (myelolipoma in 2, carcinoma in 2), seven patients had incomplete postoperative data. The statistical analysis therefore included 51 patients, of which 57% were females. CT or MRI was performed in all patients; 63% patients underwent superselective catheterization of adrenal veins (AVS). Adrenalectomy was performed in all cases laparoscopically. Histology most often showed adrenal hyperplasia (59%), adenoma was detected in 37% and adenoma on the basis of micronodular hyperplasia in 4%. Twelve months after surgery the antihypertensive drugs were discontinued in 17/51 (33%) and the number or dose of antihypertensive drugs was reduced in 25/51 (49%). Normokalemia and normalisation of the aldosterone-renin ratio (ARR) was detected in 92% and 84% of the patients. Performing AVS did not statistically significantly influence the rate of blood pressure control or normalization of ARR, which is probably due to small study size. This study demonstrated a better effect of surgery on blood pressure in younger patients. Conclusions. Unilateral adrenalectomy had a positive effect in 82% of the patients operated for primary aldosteronism and lead to either blood pressure normalization or reduction of the antihypertensive medication.

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“…Previous studies that used AVS selectively have reported no difference in outcome between patients Outcome of surgery in primary aldosteronism undergoing surgery on the grounds of a typical adenoma on CT-scan or on the grounds of lateralized AVS performed in patients without a typical adenoma on CT-scan [14,16,22,33]. Moreover, among the 19 studies reported in our literature review, the six that used AVS systematically did not have a better pooled cure rate (39%) [18][19][20]29,30,32] than the 13 that used AVS selectively (42%) [12,14,16,17,21,[23][24][25][26][27][28]31,33]. Finally, among patients with unilateral primary aldosteronism systematically diagnosed by AVS, those with the highest lateralization index did not have a higher rate of hypertension cure [29].…”

Section: Study Limitationsmentioning

confidence: 77%