Еndoscopic surgery of the suprarenal glands tumors in primary hyperaldosteronism

Keywords: primary aldosteronism; аdenoma of a suprarenal gland; laparoscopic adrenalectomy; laparoscopic resection

Abstract

Objective. To estimate the efficacy of surgical treatment of patients, suffering  primary hyperaldosteronism (PHA).

Маterials and methods. In a 2014 - Feb. 2018 yrs period in the Clinic of Hospital Surgery of the Zaporizhzhya State Medical University in 46 patients a PHA was diagnosed, оperative treatment was conducted in 23 patients, among whom there were 15 (65%) women and 8 (35%) men. The average age have constituted (52.3 ± 9.5) yrs old. In accordance to the CT and MRT data a right-sided localization of the suprarenal glands adenomas was established in 10 (43.5%) patients, a left-sided - in 7 (30.4%), and a bilateral - in 6 (26.1%). The dimensions of the volume suprarenal glands tumors have constituted (18.3 ± 6.7) mm. The diagnosis was conducted in accordance to the Clinical Practice Guideline for The Management of  Primary Aldosteronism; 2008, 2016). Оperative treatment was conducted, using endoscopic methods. Laparoscopic adrenalectomy was performed in 19 (82.6%) patients, and laparoscopic resection of a suprarenal gland - in 4 (17.4%). The results of operative treatment were estimated in accordance to standard and clinical-biochemical criteria PASO (Primary Aldosteronism Surgical Outcomes).

Results. The operation duration have constituted 150 (120 - 200) min at average, and duration of the patients’ stationary stay - (9 ± 2.1) days. There were no conversions, nor postoperative morbidity. Nobody of the patients died. Comparative analysis of the operative treatment results have shown a statistically trustworthy lowering of the systolic arterial pressure indices (САТ), diastolic arterial pressure (DAP), concentration of aldosterone and raising of the potassium level (p < 0.05). Correlation analysis did not reveal a statistically trustworthy connection between concentration of aldosterone and the left ventricle myocardial mass, the interventricle septum thickness, thickness of the left ventricle posterior wall in the patients before and after the operative treatment. Clinical results of surgical treatment of patients, suffering PHA, estimated in accordance to PASO criteria and the standard criteria, are practically similar: complete recovery was registered in 39.2 and 43.5% patients, and a partial one - in 60.8 and 56.5% patients, accordingly; biochemical results, estimated similarly, have been differed essentially: complete recovery - 91.3 and 43.5%, and a partial one - 8.7 and 56.5% accordingly.

Conclusion. In surgical treatment of the patients with the suprarenal glands adenomas, accompanied by PHA, it is mandatory to give advantage to laparoscopic  methods (аdrenalectomy, resection). The efficacy of miniinvasive methods of surgical treatment of PHA is statistically trustworthy. Clinico-biochemical criteria PASO in estimation of the surgical treatment results in patients, suffering PHA, have advantage over the standard, because they are complex. After surgical treatment of the patients, suffering PHA, a complete biochemical recovery occurs in 91.3% patients, complete clinical one - in 39.2%, partial biochemical - in 8.7%, partial clinical - in 60.8%.

Author Biographies

A. O. Nykonenko, Zaporizhzhya State Medical University

Nykonenko Andryi. O. -  MD, PhD, DSci., Professor,

Head of Department of Hospital Surgery,

Zaporizhzhia State Medical University,

Maiakovskyi avenue 26, 69035,Zaporizhzhia, Ukraine

+38 061 224 63 91

nikonandra@gmail.com

orcid.org/0000-0002-5720-2602

I. V. Rusanov, Zaporizhzhya Medical Academy of Postgraduate Education

Rusanov Ihor V. -  MD, PhD, Associate Professor,

Department of transplantology and endocrine surgery with the course of cardiovascular surgery,

Zaporizhia Medical Academy of Postgraduate Education,

Vintera boulevard 20, 69096, Zaporizhia, Ukraine

+38 061 279 01 92

r69050@gmail.com

orcid.org/0000-0002-4363-1158

I. V. Zubryk, Zaporizhzhya State Medical University

Zubryk Iryna. V. -  MD, Postgraduate student,

Department of Hospital Surgery,

Zaporizhzhia State Medical University

Maiakovskyi avenue 26, 69035,Zaporizhzhia, Ukraine

+38 061 224 63 91

lirinavit@gmail.com

orcid.org/0000-0002-5578-133X

O. O. Podluzhnyi, Zaporizhzhya State Medical University

Podluzhnyi Oleksandr. O. -  MD, PhD, Assistant,

Department of Hospital Surgery,

Zaporizhzhia State Medical University

Maiakovskyi avenue 26, 69035, Zaporizhzhia, Ukraine

+38 061 224 63 91

alexpodluzhnyi@yahoo.com

orcid.org/0000-0001-9923-2431

A. L. Makarenkov, Zaporizhzhya State Medical University

Makarenkov Andrii. L. -  MD, Postgraduate student,

Department of Hospital Surgery,

Zaporizhzhia State Medical University,

Maiakovskyi avenue 26, 69035, Zaporizhzhia, Ukraine

+38 061 224 63 91 angio.zp@gmail.com

orcid.org/0000-0003-2132-3776

References

1. Sotelo R, Arriaga J, Aron M editors. Complications in Robotic Urologic Surgery. Springer; 2018. 135-9. doi: 10.1007/978-3-319-62277-4.
2. Rybakov SІ. History of surgery of adrenal cortex tumors (part 1). Klinichna endokrynolohia ta endocrynna khirurhiia, 2013;3(44):55-60. doi:10.24026/1818-1384. [In Ukrainian].
3. Chen SF, Chueh SC, Wang SM, Wu VC, Pu YS, Wu KD, Huang KH. Clinical outcomes in patients undergoing laparoscopic adrenalectomy for unilateral aldosterone producing adenoma: partial versus total adrenalectomy. J Endourol. 2014 Sep; 28(9):1103-6. doi: 10.1089/end.2014.0102.
4. Van Uitert A, d’ Ancona FCH, Deinum J, Timmers HJLM, Langenhuijsen JF. Evaluating the learning curve for retroperitoneoscopic adrenalectomy in a high-volume center for laparoscopic adrenal surgery. Surg Endosc. 2017 Jul;31(7):2771-5. doi: 10.1007/s00464-016-5284-0.
5. Taskin HE, Berber E. Robotic adrenalectomy. Cancer J. 2013 Mar-Apr;19(2):162-6. doi: 10.1097/PPO.0b013e31828ba0c7.
6. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 May;101(5):1889-916. doi: 10.1210/jc.2015-4061.
7. Shchkaturova LV. Essential issues of diagnostic of primary hyperaldosteronism. Klinichna endocrynolohia ta endokrynna khirurhia, 2015; 2(50):77-80. doi: 10.24026/1818-1384.2(50).2015.74990. [in Ukrainian].
8. Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. Primary Aldosteronism Surgery Outcome (PASO) investigators. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017 Sep;5(9):689-99. doi: 10.1016/S2213-8587(17)30135-3.
9. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017 Apr 11;69(14):1811-20. doi: 10.1016/j.jacc.2017.01.052.
10. Prejbisz A, Warchoł-Celińska E, Lenders JW, Januszewicz A. Cardiovascular risk in primary hyperaldosteronism. Horm Metab Res. 2015 Dec;47(13):973-80. doi: 10.1055/s-0035-1565124.
11. Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension. 2013 Jul;62(1):62-9. doi: 10.1161/HYPERTENSIONAHA.113.01316.
12. Marzano L, Colussi G, Sechi LA, Catena C. Adrenalectomy is comparable with medical treatment for reduction of left ventricular mass in primary aldosteronism: meta-analysis of long-term studies. Am J Hypertens. 2015 Mar;28(3):312-8. doi: 10.1093/ajh/hpu154.
13. Zennaro MC, Boulkroun S, Fernandes-Rosa F. An update on novel mechanisms of primary aldosteronism. J Endocrinol.2015 Feb;224(2):R63-77. doi: 10.1530/JOE-14-0597.
14. Miller BS, Turcu AF, Nanba AT, Hughes DT, Cohen MS, Gauger PG, Auchus RJ. Refining the definitions of biochemical and clinical cure for primary aldosteronism using the primary aldosteronism surgical outcome (PASO) classification system. World J Surg. 2018 Feb;42(2):453-63. doi: 10.1007/s00268-017-4311-1.
15. Williams TA, Lenders WM, Mulatero P, et al. Outcome of adrenalectomy for unilateral primary aldosteronism: international consensus and remission. Lancet Diabetes Endocrinol. 2017 Sep;5(9):689-99. doi: 10.1016/S2213-8587(17)30135-3.
Published
2018-10-29
Section
General Problems of Surgery

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