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Anceschi U, Tufano A, Flammia RS, Mormando M, Fiori C, Zappalà O, De Concilio B, Carrara A, Maria Consiglia F, Tuderti G, Brassetti A, Misuraca L, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Gallucci M, Simone G. 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. Cent European J Urol 2023; 75:345-351. [PMID: 36794029 PMCID: PMC9903164 DOI: 10.5173/ceju.2022.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023] Open
Abstract
Introduction Several predictive scores to evaluate outcomes of adrenal surgery for unilateral primary aldosteronism (UPA), have been conceived. We compared a novel trifecta that summarizes outcomes of adrenal surgery for UPA with the clinical cure proposed by Vorselaars. Material and methods Between March 2011 and January 2022, a multi-institutional dataset was queried for UPA. Baseline, perioperative and functional data were collected. Clinical and biochemical complete and partial success rates according to Primary Aldosteronism Surgical Outcome (PASO) criteria were assessed for the overall cohort. Clinical cure was defined either as normotension without antihypertensive medications or normotension with lower or equal use of antihypertensive medications. Trifecta was defined as the coexistence of ≥50% antihypertensive therapeutic intensity score (TIS) reduction (ΔTIS), no electrolyte impairment at 3-months and no Clavien-Dindo (2-5) complications. Cox regression analyses were used to identify predictors of long-term clinical and biochemical success. For all analyses, a two-sided p <0.05 was considered significant. Results Baseline, perioperative and functional outcomes were analyzed. Out of 90 patients, at a median follow-up of 42 months (IQR 27-54) a complete and partial clinical success was observed in 60% and 17.7% of cases while a complete and partial biochemical success was achieved in 83.3% and 12.3% of cases, respectively. Overall trifecta and clinical cure rates were 21.1% and 58.9%, respectively. On multivariable Cox regression analysis, trifecta achievement (HR 2.87; 95% CI 1.45-5.58; p = 0.02) was the only independent predictor of complete clinical success at long-term follow-up. Conclusions Despite its complex estimation and more restrictive criteria, trifecta but not clinical cure allows to independently predict composite PASO endpoints on the long run.
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Affiliation(s)
- Umberto Anceschi
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Marilda Mormando
- Oncological Endocrinology Unit, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi-Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Orazio Zappalà
- Department of General Surgery, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Bernardino De Concilio
- Department of Urology, ULSS 7 Pedemontana - San Bassiano Hospital, Bassano del Grappa, Italy
| | - Alessandro Carrara
- Department of General Surgery, Santa Maria del Carmine Hospital, Azienda Sanitaria per i Servizi Sanitari, Rovereto, Italy
| | | | - Gabriele Tuderti
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Giuseppe Tirone
- Department of General Surgery, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi-Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Antonio Celia
- Department of Urology, ULSS 7 Pedemontana - San Bassiano Hospital, Bassano del Grappa, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
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