Laparoscopic Partial Versus Unilateral Adrenalectomy For Aldosterone-producing Adenoma: Comparative Study Of Perioperative And Long-term Results

Objective:Aldosterone-producing adenoma is an important course of primary aldosteronism which accounts for a great part of secondary hypertension. In this series we evaluated the differences of perioperative and long-term results for unilateral aldosterone-producing adenoma between laparoscopic partial and unilateral adrenalectomy.Methods:We studied retrospectively the clinical data of 103 patients of primary aldosteronism who caused by unilateral aldosterone-producing adenoma between April 2004 and June 2009. There were 46(44.7%) males and 57(55.3%) females with a age of 47.8±12.2 years(54 in right and 49 in left).69(67%) patients underwent laparoscopic partial adrenalectomy(LPA) and 34(33%) underwent laparoscopic total adrenalectomy(LTA). Effect of operation was classifeid as cured, improved and refractory according improvement of hypertension. Cure was defined as normal blood pressure without antihypertension medications, improvement was defined by reduction of antihypertension medications≥50% and hypertension can be controled, refractory was defined by no decrease of blood pressure and reduction of antihypertension medications <50%.Results:All procedures were finished laparoscopically, and no conversion was necessary. No major intraoperative or postoperative complication was observed. There were no significant differences between LPA and LTA in terms of duration of surgery, intraoperative blood loss, mean hospital stay after operation and complication. The histologic examination showed adenomas in all cases of LPA and adenomas with multiple lesions in 34 patients of LTA. There were remarkable differences between LPA and LTA in term of prognostic composition of blood pressure with 44 cases cured, 24 cases improved,1 case failured in LTA versus 21 cases cured,9 cases improved,4 cases failured in LPA. In the 4 failured cases of LPA,3 cases got a high blood pressure and plasma aldosterone after a transient time of 8 months,1.5 years and 3 years respectively, the plasma patassium and aldosterone were within normal ranges in the rest cases.Conclusion:There were no significant differences between LPA and LTA in duration of surgery, intraoperative blood loss, mean hospital stay after operation and complication. But LPA has the possibility of recurrence, by comparison the curative effect of LTA is more definite. So, we advocate LTA for unilateral aldosterone-producing adenoma.