ENDOUROLOGY & LAPAROSCOPY

doi: 10.1590/S1677-55382011000200017

Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma
Fu B, Zhang X, Wang GX, Lang B, Ma X, Li HZ, Wang BJ, Shi TP, Ai X, Zhou HX, Zheng T
Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
J Urol. 2011; 185: 1578-82

• Purpose: The indication for laparoscopic total or partial adrenalectomy in patients with aldosterone producing adrenal adenoma remains controversial. We compared retroperitoneoscopic partial and total adrenalectomy for aldosterone producing adrenal adenoma in a prospective, randomized, multicenter trial.
  Materials and Methods: Patients with aldosterone producing adrenal adenoma were randomized to retroperitoneoscopic partial or total adrenalectomy. Patient characteristics, surgical data, complications and postoperative clinical results were analyzed statistically.
  Results: From July 2000 to March 2004, 212 patients were enrolled in this study, including 108 and 104 who underwent total and partial adrenalectomy, respectively. The 2 groups were comparable in patient age, gender, body mass index and tumor site. Mean follow-up was 96 months in each group. No conversion to open surgery was needed and no major complications developed. Partial adrenalectomy required a shorter operative time than total adrenalectomy but this did not attain statistical significance. Intraoperative blood loss in the partial adrenalectomy group was significant higher than in the total adrenalectomy group (p < 0.05) but no patient needed blood transfusion. All patients in each group showed improvement in hypertension, and in all plasma renin activity and aldosterone returned to normal after surgery. No patient required potassium supplements postoperatively. In the total and partial adrenalectomy groups 32 (29.6%) and 29 patients (27.9%), respectively, were prescribed a decreased dose of or fewer antihypertensive medicines at final follow-up.
  Conclusions: Retroperitoneoscopic partial adrenalectomy is technically safe. It has therapeutic results similar to those of total adrenalectomy in patients with primary aldosteronism due to aldosteronoma.

• Editorial Comment
  The authors compared retroperitoneoscopic partial and total adrenalectomy for aldosterone producing adrenal adenoma in a prospective, randomized, multicenter trial. Primary aldosteronism often has a higher rate of cardiovascular complications, target organ damage and metabolic syndrome than essential hypertension. The laparoscopic removal of the adenoma has shown preferable and more beneficial than medical treatment or open surgery to manage functioning adrenal tumors. The authors ask an important and controversial question of organ-sparing adrenalectomy in patients with primary aldosteronism due to aldosteronoma. Moreover, they questioned the role of adrenal vein sampling as the gold standard diagnostic test to identify the side of aldosterone secretion versus high-resolution computerized axial tomography. The data revealed a total of 212 patients enrolled in this study, including 108 that underwent total adrenalectomy and 104 patients in the partial adrenalectomy group. No open conversion or blood transfusions were needed. No major intraoperative complications occurred and no tumor recurrence was noted during the mean 96-month follow-up. All patients in each group showed improvement in hypertension and in all plasma renin activity and plasma aldosterone recovered to normal after surgery. However, 32 of 108 patients (29.6%) with total adrenalectomy remained hypertensive with normal plasma aldosterone after surgery. Blood pressure was managed with 20 or 40 mg nifedipine retard daily. Patients with partial adrenalectomy no longer required antihypertensive medication after surgery and 29 patients (27.9%) were prescribed a decreased dose or fewer antihypertensive medications. The authors concluded that partial adrenalectomy for unilateral aldosterone producing adrenal adenoma is beneficial and may preserve adrenal function avoiding possible steroid replacement. Moreover, retroperitoneoscopic partial adrenalectomy is technically feasible with similar outcomes as total adrenalectomy in patients with primary aldosteronism due to aldosteronoma.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med. Ctr.
Associate Professor, Univ. Colorado Health Sci. Ctr.
Director of Minimally Invasive Urol. Oncology, UCHSC
Denver, Colorado, USA
E-mail: fernando.kim@dhha.org