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Laparoscopic adrenalectomy vs. radiofrequency ablation for the treatment of primary aldosteronism. A single center retrospective cohort analysis adjusted with propensity score

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Abstract

Background

Laparoscopic adrenalectomy (LA) is the gold standard treatment for unilateral primary aldosteronism. However, satisfactory results have also been published with radiofrequency ablation (RFA). The aim of this study was to compare LA and RFA for the treatment of primary aldosteronism.

Methods

A retrospective cohort study of the patients who underwent LA or RFA in a single center was performed. Morbidity and long-term effectiveness (cure rate and blood pressure control) were analyzed. A multivariate analysis with a propensity score was also performed.

Results

Thirty-four patients were included in the study, 24 in the LA group and 10 in the RFA group. Hypertension had been diagnosed a median of 12 years before the intervention. Hypertension was properly controlled before the intervention in 55.9% of the patients. Hypertensive crisis was more common during RFA (4.2% vs. 70.0%, p < 0.001), although no patient suffered any complication because of these crises. LA was longer (174.6 vs. 105.5 min, p = 0.001) and had a longer length of stay (median 2 vs 1 days, p < 0.001). No severe complications were observed in any of the patients. After a median follow-up of 46.2 months, more patients had hypertension cured and blood pressure controlled in the LA group (29.2% vs. 0%, p = 0.078 and 95.5% vs. 50.0%, p = 0.006, respectively). Also, patients in the LA group were taking less antihypertensive drugs (1.8 vs. 3.0, p = 0.054) or mineralocorticoid receptor antagonists (41.7% vs. 90.0%, p = 0.020). Multivariate analysis adjusted by propensity score showed that LA had an OR = 11.3 (p = 0.138) for hypertension cure and an OR = 55.1 (p = 0.040) for blood pressure control.

Conclusions

Although RFA was a less invasive procedure than LA, hypertension was cured and blood pressure was properly controlled in more patients from the LA group. Patients who underwent LA were taking less antihypertensive drugs than patients who had undergone RFA.

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Authors and Affiliations

  1. Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain

    Oscar Cano-Valderrama, Santiago Ochagavía & Antonio J. Torres

  2. Department of Surgery, Universidad Complutense, Madrid, Spain

    Oscar Cano-Valderrama, Santiago Ochagavía & Antonio J. Torres

  3. Instituto de Investigación Sanitaria San Carlos, Madrid, Spain

    Oscar Cano-Valderrama, María Abad-Cardiel, José A. García-Donaire, Antonio J. Torres & Nieves Martell-Claros

  4. Interventional Radiology Unit, Hospital Clínico San Carlos, Madrid, Spain

    Jimena González-Nieto, José V. Méndez & Javier E. Armijo

  5. Hypertension Unit, Hospital Clínico San Carlos, Madrid, Spain

    María Abad-Cardiel, José A. García-Donaire & Nieves Martell-Claros

  6. Department of Medicine, Universidad Complutense, Madrid, Spain

    María Abad-Cardiel & Nieves Martell-Claros

  7. Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain

    Isabelle Rünkle, Martín Cuesta-Hernández & Paz Miguel-Novoa

Authors
  1. Oscar Cano-Valderrama
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  2. Jimena González-Nieto
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  3. María Abad-Cardiel
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  4. Santiago Ochagavía
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  8. Martín Cuesta-Hernández
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  12. Nieves Martell-Claros
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Corresponding author

Correspondence to Oscar Cano-Valderrama.

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Disclosures

Dr. Oscar Cano-Valderrama, Jimena González-Nieto, María Abad-Cardiel, Santiago Ochagavía, Isabelle Rünkle, José V. Méndez, José A. García-Donaire, Martín Cuesta-Hernández, Javier E. Armijo, Paz Miguel-Novoa, Antonio J. Torres and Nieves Martell-Claros have no conflicts of interest or financial ties to disclose.

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Cano-Valderrama, O., González-Nieto, J., Abad-Cardiel, M. et al. Laparoscopic adrenalectomy vs. radiofrequency ablation for the treatment of primary aldosteronism. A single center retrospective cohort analysis adjusted with propensity score. Surg Endosc 36, 1970–1978 (2022). https://doi.org/10.1007/s00464-021-08481-3

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  • DOI: https://doi.org/10.1007/s00464-021-08481-3

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