Hypertension Cure Following Laparoscopic Adrenalectomy for Hyperaldosteronism is not Universal: Trends Over Two Decades

• Published in: World journal of surgery Vol. 41; no. 4; pp. 986 - 990
• Main Authors: Namekawa, Takeshi, Utsumi, Takanobu, Tanaka, Tomoaki, Kaga, Mayuko, Nagano, Hidekazu, Kono, Takashi, Kawamura, Koji, Kamiya, Naoto, Imamoto, Takashi, Suzuki, Hiroyoshi, Ichikawa, Tomohiko
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Adrenal Vein Sampling; Adrenalectomy; Age Factors; Body Mass Index; Cardiac Surgery; Diabetes Mellitus - epidemiology; Female; General Surgery; Humans; Hyperaldosteronism - surgery; Hypertension - surgery; Hypertension Cure; Laparoscopic Adrenalectomy; Laparoscopy; Male; Medicine; Medicine & Public Health; Middle Aged; Original Scientific Report; Plasma Aldosterone Concentration; Potassium - blood; Primary Aldosteronism; Renin - blood; Retrospective Studies; Sex Factors; Surgery; Thoracic Surgery; Vascular Surgery; Adrenal Vein Sampling; Hypertension Cure; Plasma Aldosterone Concentration; Primary Aldosteronism; Laparoscopic Adrenalectomy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3822-5

Background Laparoscopic adrenalectomy has been established as a standard surgical method for unilateral primary aldosteronism. Meanwhile, the background characteristics of the patients undergoing adrenalectomy have changed over the last 20 years. The aim of this study was to investigate the changes in hypertension cure rates after laparoscopic adrenalectomy during the last two decades. Methods This retrospective clinical study included 176 patients who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism from 1995 to 2015. The patients were divided into two groups by decade. The patients’ baseline characteristics and the hypertension cure rates were compared between the two groups. Additionally, the values were re-examined based on predictive model predicting postoperative hypertension cure. Results The hypertension cure rate decreased significantly from 51.8 to 31.1%. The following variables were significantly different between the two groups: age, sex, body mass index, history of diabetes mellitus, preoperative systolic and diastolic blood pressures, potassium level, and plasma renin activity. Conclusions This study showed that the number of patients with unfavorable conditions for hypertension cure after adrenalectomy has recently increased. The treatment goal for primary aldosteronism is not only to cure the hypertension but also to prevent organ disorders due to inappropriate aldosterone levels. Therefore, we recommend laparoscopic adrenalectomy for unilateral primary aldosteronism, even if hypertension is not always cured postoperatively. However, clinicians need to fully explain the postoperative hypertension outcomes to primary aldosteronism patients.