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Robotic Assisted Adrenalectomy: Is it Ready for Prime Time?
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Robotic Assisted Adrenalectomy: Is it Ready for Prime Time?

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 5905

Special Issue Editor

Dr. Giuseppe Simone

E-Mail Website1 Website2
Guest Editor
Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Interests: robotic surgery; urologic oncology; radical cystectomy; partial nephrectomy; advanced prostate cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Partial adrenalectomy has proved to be an alternative option to total adrenalectomy for functioning adrenal adenomas. While the rationale behind its role is intrinsically based on improved preservation of adrenal gland and function, this surgical approach remains underused mainly due to overuse of total adrenalectomy. Despite the remaining function of contralateral adrenal gland, total adrenalectomy may lead to increased need for steroidal replacement during follow-up, especially in patients with bilateral disease or in young patients exposed to risk of metachronous development of contralateral disease.

This Special Issue aims to highlight the safety and effectiveness of partial adrenalectomy in a head to head comparison with total adrenalectomy that remains the actual standard of care.

Dr. Giuseppe Simone
Guest Editor

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Keywords

  • minimally invasive
  • partial adrenalectomy
  • total adrenalectomy
  • robotic

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Published Papers (3 papers)

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Research

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9 pages, 514 KiB  
Article
The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
by Umberto Anceschi, Marilda Mormando, Rocco Simone Flammia, Cristian Fiori, Orazio Zappalà, Bernardino De Concilio, Aldo Brassetti, Alessandro Carrara, Maria Consiglia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Francesco Prata, Antonio Tufano, Alfredo Maria Bove, Riccardo Mastroianni, Marialuisa Appetecchia, Giuseppe Tirone, Francesco Porpiglia, Antonio Celia and Giuseppe Simone
J. Clin. Med. 2023, 12(3), 997; https://doi.org/10.3390/jcm12030997 - 28 Jan 2023
Cited by 2 | Viewed by 1379
Abstract
Background: To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Methods: Between 2011 and 2022, a four-center adrenalectomy dataset was queried for “unilateral adrenal mass” and “UPA” (n = [...] Read more.
Background: To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Methods: Between 2011 and 2022, a four-center adrenalectomy dataset was queried for “unilateral adrenal mass” and “UPA” (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan–Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. Results: At a median follow-up of 42 months (IQR 27–54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan–Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11–0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1–1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32–6.1; p = 0.007) was the only independent predictor of absent clinical success. Conclusions: TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery. Full article
(This article belongs to the Special Issue Robotic Assisted Adrenalectomy: Is it Ready for Prime Time?)
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15 pages, 1224 KiB  
Article
Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism
by Umberto Anceschi, Marilda Mormando, Cristian Fiori, Orazio Zappalà, Bernardino De Concilio, Aldo Brassetti, Alessandro Carrara, Maria Consiglia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Alfredo Maria Bove, Riccardo Mastroianni, Alfonsina Chiefari, Marialuisa Appetecchia, Giuseppe Tirone, Francesco Porpiglia, Antonio Celia, Michele Gallucci and Giuseppe Simone
J. Clin. Med. 2022, 11(3), 794; https://doi.org/10.3390/jcm11030794 - 1 Feb 2022
Cited by 6 | Viewed by 1615
Abstract
Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and [...] Read more.
Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and no Clavien grade 2–5. Logistic regression was used to identify predictors of trifecta. Probability of clinical, biochemical, and simultaneous success according to trifecta were assessed by Kaplan–Meier. Cox regression was used to identify predictors of long-term clinical, biochemical, and simultaneous success. For all analyses, a two-sided p < 0.05 was considered significant. Results: Simultaneous success rate was 50%. On multivariable analysis, TIS was an independent predictor of trifecta achievement (HR 3.28; 95% CI 1.07–10.9; p = 0.03). At Kaplan–Meier, trifecta predicted higher success for all endpoints (each p < 0.03). On multivariable Cox analysis, adenoma size (AS) ≥6 cm and trifecta were independent predictors of biochemical (AS: HR 2.87; 95% CI 1.53–5.36; trifecta: HR 2.1; 95% CI 1.13–3.90; each p < 0.02) and simultaneous success (AS: HR 3.81; 95% CI 1.68–8.65; trifecta: HR 4.29; 95% CI 2.08–8.86; each p < 0.01), while trifecta was an independent predictor of complete clinical success (HR 2.84; 95% CI 1.45–5.58; p < 0.01). Conclusions: Trifecta and AS are independent predictors of either long-term complete clinical, biochemical, or combined success after adrenalectomy for UPA. Full article
(This article belongs to the Special Issue Robotic Assisted Adrenalectomy: Is it Ready for Prime Time?)
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Review

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14 pages, 1606 KiB  
Review
Minimally Invasive Partial vs. Total Adrenalectomy for the Treatment of Unilateral Primary Aldosteronism: A Systematic Review and Meta-Analysis
by Rocco Simone Flammia, Umberto Anceschi, Antonio Tufano, Eugenio Bologna, Flavia Proietti, Alfredo Maria Bove, Leonardo Misuraca, Riccardo Mastroianni, Giuseppe Tirone, Alessandro Carrara, Lorenzo Luciani, Tommaso Cai, Costantino Leonardo and Giuseppe Simone
J. Clin. Med. 2022, 11(5), 1263; https://doi.org/10.3390/jcm11051263 - 25 Feb 2022
Cited by 10 | Viewed by 2404
Abstract
Background: 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). Material and Methods: Multiple scientific databases (PUBMED, Web of Science, and Cochrane [...] Read more.
Background: 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). Material and Methods: 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. Results: Overall, a total of 802 patients from six eligible studies were identified, with mi-PA and mi-TA performed in 40.4% (n = 324) and 59.6% (n = 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. Conclusions: 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. Full article
(This article belongs to the Special Issue Robotic Assisted Adrenalectomy: Is it Ready for Prime Time?)
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