Radiofrequency ablation versus laparoscopic adrenalectomy for aldosterone-producing adenomas: a systematic review and meta-analysis.

Abstract

Purpose: To compare the clinical effectiveness and safety of radiofrequency ablation (Ablation) and laparoscopic adrenalectomy (LA) for treating patients with aldosterone-producing adenomas (APA).

Methods: A comprehensive literature search was conducted using multiple databases from inception to April 2024. Randomized controlled trials and retrospective studies comparing Ablation and LA for APA were included. Data on efficacy, safety, and other relevant outcomes were extracted and pooled using random-effects meta-analysis. Quality assessment was performed using the Newcastle-Ottawa Scale.

Results: Ten studies with 887 patients (414 in the Ablation group, 473 in the LA group) were included. Pooled analysis showed comparable clinical success rates (74.2% in Ablation vs. 82% in LA, p = 0.52) but a significantly higher rate of hypertension crises in the Ablation group (16.4 vs. 3%, p < 0.0001). Resolution of hypertension was more frequent in the LA group (44 vs. 27.2%, p = 0.003). Ablation was associated with lower intraoperative blood loss and shorter hospital stays. Still, no significant differences were found in the resolution of primary aldosteronism, complication rates, blood pressure reduction, or medication usage.

Conclusions: Both Ablation and LA demonstrate comparable efficacy in treating APA, with Ablation offering advantages in terms of lower intraoperative blood loss and shorter hospital stay. However, Ablation may be associated with a higher rate of hypertension crises during the procedure. The results suggest that Ablation is not yet a substitute for LA. A personalized approach considering patient-specific factors and institutional expertise is warranted when selecting the appropriate treatment.