Flammia Rocco Simone, Anceschi Umberto, Tufano Antonio, Bologna Eugenio, Proietti Flavia, Bove Alfredo Maria, Misuraca Leonardo, Mastroianni Riccardo, Tirone Giuseppe, Carrara Alessandro, Luciani Lorenzo, Cai Tommaso, Leonardo Costantino, Simone Giuseppe
Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
J Clin Med. 2022 Feb 25;11(5):1263. doi: 10.3390/jcm11051263.
This systematic review and metanalysis was conducted to assess differences between perioperative and functional outcomes in patients undergoing minimally-invasive partial (mi-PA) and total adrenalectomy (mi-TA) for unilateral primary aldosteronism (uPHA).
Multiple scientific databases (PUBMED, Web of Science, and Cochrane Library) were searched up to November 2021 for surgical series comparing mi-PA vs. mi-TA for uPHA according to the PRISMA statement. Primary outcomes of interest were perioperative and functional outcomes.
Overall, a total of 802 patients from six eligible studies were identified, with mi-PA and mi-TA performed in 40.4% ( = 324) and 59.6% ( = 478) of cases, respectively. No differences were recorded between the two groups according to number of transfusions, EBL and Clavien-Dindo complications ≥2. Similarly, no differences in clinical success, persistence of postoperative hypokalemia and improvement in HTN were reported between mi-PA and mi-TA.
In a uPHA setting, mi-PA and mi-TA provide comparable perioperative and functional outcomes despite the use of mi-PA remains limited to patients with small adenoma size, or hereditary/bilateral disease. Due to limited use of standardized reporting criteria in most of current series, the quest for a superiority of mi-PA over mi-TA in the treatment of uPHA still remains open.
本系统评价和荟萃分析旨在评估接受微创部分肾上腺切除术（mi-PA）和全肾上腺切除术（mi-TA）治疗单侧原发性醛固酮增多症（uPHA）患者的围手术期和功能结局差异。
根据PRISMA声明，检索多个科学数据库（PUBMED、Web of Science和Cochrane图书馆），截止至2021年11月，查找比较mi-PA与mi-TA治疗uPHA的手术系列研究。感兴趣的主要结局为围手术期和功能结局。
总体而言，共纳入六项符合条件研究中的802例患者，其中mi-PA和mi-TA分别占40.4%（n = 324）和59.6%（n = 478）。两组在输血次数、估计失血量（EBL）和Clavien-Dindo并发症≥2级方面无差异。同样，mi-PA和mi-TA在临床成功率、术后低钾血症持续存在情况和高血压改善方面也无差异。
在uPHA患者中，mi-PA和mi-TA的围手术期和功能结局相当，尽管mi-PA目前仍仅限于腺瘤体积小或遗传性/双侧疾病患者。由于目前大多数系列研究中标准化报告标准的使用有限，mi-PA在治疗uPHA方面是否优于mi-TA仍有待进一步探讨。
