The role of adrenal-sparing surgery in the management of aldosterone-producing adenoma: a systematic review and meta-analysis

Objective The indication for laparoscopic partial adrenalectomy (LPA) in patients with primary aldosteronism due to aldosterone-producing adenoma (APA) remains controversial. This study aimed to determine the functional and surgical outcomes of LPA in this context. Methods This is a systematic review and meta-analysis. MEDLINE and Embase were searched until May 2024. Biochemical and clinical outcomes were defined according to the PASO criteria. Results A total of 3,515 articles were initially identified, and eventually 20 studies (8 comparative, 12 single-arm) were included. The pooled biochemical success and clinical response rates (hypertension improvement) were estimated to be 100% (95%CI 99-100) and 91% (95%CI 48-99), respectively. The postoperative complication risk was very low (1%, 95%CI 0-4). The pooled recurrence risk was 0% (95%CI 0-1) over a mean follow-up of 25.9 months (range: 12-39 months). Eight comparative studies were combined in quantitative analyses. The biochemical success (OR 0.80, 95%CI 0.38-1.72), clinical cure (OR 1.07, 95%CI 0.77-1.50), recurrence (OR 1.57, 95%CI 0.25-9.77) and need for steroid supplementation (OR 0.96, 95%CI 0.27-3.44) rates were similar between LPA and total adrenalectomy groups. Notwithstanding, LPA had a lower postoperative complication risk (OR 0.51, 95%CI 0.31-0.82). Conclusions Our systematic review underscores that LPA for treating APA has similar functional outcomes in terms of biochemical success and clinical response compared to 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.