PD04-05: Clinical cure vs a novel trifecta system for evaluating long-term outcomes of minimally-invasive partial or total adrenalectomy for unilateral primary aldosteronism: results of a multicentric series
Friday, May 13, 2022
7:40 AM – 7:50 AM
Location: Room 244
Umberto Anceschi*, Riccardo Mastroianni, Gabriele Tuderti, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Marilda Mormando, Rome, Italy, Alessandro Carrara, Trento , Italy, Bernardino De Concilio, Bassano del Grappa , Italy, Leonardo Misuraca, Rome, Italy, Orazio Zappalà, Trento , Italy, Cristian Fiori, Orb, Italy, Marialuisa Appetecchia, Rome, Italy, Antonio Celia, Bassano del Grappa , Italy, Francesco Porpiglia, Orbassano , Italy, Giuseppe Tirone, Trento , Italy, Michele Gallucci, Giuseppe Simone, Rome, Italy
Introduction: In order to critically evaluate long-term functional outcomes of adrenal surgery for primary aldosteronism (PA), several predictive scores have been recently conceived. We compared a novel trifecta system that summarizes outcomes of adrenal surgery for Conn’ syndrome regardless the surgical technique with the standard clinical cure criteria proposed by Vorselaars.
Methods: A multicenter minimally-invasive adrenalectomy dataset was queried for “unilateral adrenal mass” and “primary aldosteronism (PA)” at 4 participating institutions between 2011-2021. Clinical and biochemical complete, partial and absent success rates according to PASO criteria were assessed for the overall cohort. Trifecta was defined as the coexistence of =50% antihypertensive therapeutic intensity score (TIS) reduction (?TIS) and no electrolyte impairment at 3-months after surgery, no Clavien-Dindo (2-5) complications. Probability of absent clinical success according to non-achievement of trifecta and clinical failure were estimated by Kaplan-Meier method, respectively. Cox regression analyses were used to identify predictors of long-term clinical success. For all analyses, a two-sided p<0.05 was considered significant.
Results: Out of 90 patients, at a median follow-up of 42 months (IQR 27-54) a complete, partial, and absent clinical success was observed in 60%, 17.7%, 22.3% of cases while a complete, partial and absent biochemical success was achieved in 83.3%, 12.3%, 4.4% respectively. Overall trifecta and clinical cure rates were 21.1% and 58.9%, respectively (Tab.1). On Kaplan-Meier analysis, both trifecta and clinical failure predicted higher absent clinical success rates (each p<0.001; Fig. 1,2). On multivariable Cox regression analysis, trifecta achievement (HR 2.10; 95% CI 1.13-3.90; p=0.018) was the only independent predictor of complete clinical success at long-term follow-up
Conclusions: Compared to clinical cure, trifecta can be used to differentiate patients who are likely to achieve a stable and complete clinical success after partial and total adrenalectomy from those who will need continuous surveillance after treatment due to persistent or refractory hypertension on the long run