Efficacy and safety of radiofrequency ablation and laparoscopic adrenalectomy for primary aldosteronism: a meta‑analysis

Ruchao Ma; Gang Chen; Taotao Wei; Guiqing Ma; Ruixia Song; Ying Feng; Xin Lin

doi:10.1007/s00261-024-04297-6

Efficacy and safety of radiofrequency ablation and laparoscopic adrenalectomy for primary aldosteronism: a meta‑analysis

Abdom Radiol (NY). 2024 May 14. doi: 10.1007/s00261-024-04297-6. Online ahead of print.

Authors

Ruchao Ma¹, Gang Chen¹, Taotao Wei¹, Guiqing Ma¹, Ruixia Song¹, Ying Feng¹, Xin Lin²

Affiliations

¹ Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China.
² Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China. linxin1145@163.com.

PMID: 38743285
DOI: 10.1007/s00261-024-04297-6

Abstract

Objective: To compare the efficacy (including blood pressure, medication reduction, serum potassium, and clinical success) and safety parameters (including operative time, length of hospital stay, blood loss, hypertension crisis rate, and complication rate) of radiofrequency ablation (RFA) and laparoscopic adrenalectomy (LA) in the treatment of primary aldosteronism (PA).

Methods: Literature search was performed on PubMed, EMBASE, The Cochrane Library (Issue 8, 2023), Web of Science, China National Knowledge Infrastructure, and Wanfang from inception to August 2023. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Quality assessment was conducted using the Newcastle-Ottawa scale. The Stata 12.0 software was used for statistical analyses. Pooled odds ratios (OR) with corresponding 95% confidence interval (CI) were calculated for categorical outcomes, while mean difference (MD) with corresponding 95% CI were calculated for continuous outcomes.

Results: A total of 5 studies involving 204 patients (LA, n = 127; and RAF, n = 77) were included. LA had better diastolic blood pressure control than RFA (WMD = 5.19; 95% CI 0.96-9.43); however, the RFA demonstrated better shorter operative time (WMD = - 57.99; 95% CI - 116.54 to 0.57), and shorter length of hospital stay (OR - 1.6; 95% CI - 2.37 to - 0.83) compared to LA. All remaining parameters were comparable between the interventions.

Conclusion: While grossly comparable in efficacy as treatment options for PA, RFA may allow for shorter operative time and hospital stay, less intraoperative blood loss, and lower hospitalization costs. However, LA has better diastolic blood pressure control. Even so, we still need larger prospective studies, specifically with comparative hypertension response (short and long term) and number of post-procedural antihypertensive medication requirement.

Keywords: Adrenalectomy; Efficacy; Primary aldosteronism; Radiofrequency ablation; Safety.

Publication types

Review