Minimally-invasive partial versus total adrenalectomy for unilateral aldosterone-producing adenomas and pheochromocytoma: long-term results from a multicenter Italian study applying the clinical cure system

BACKGROUND: The aim of this study is to compare the long-term clinical outcomes of minimally invasive partial adrenalectomy (MIPA) and minimally invasive total adrenalectomy (MITA) in patients with benign functional adrenal disease, using a standardized clinical outcome metric. METHODS: We conducted a retrospective, multicenter cohort study across six Italian institutions involved in the surgical management of adrenal disease. A total of 212 patients underwent MIPA (N.=41) or MITA (N.=171) for primary aldosteronism (PA, N.=111) or pheochromocytoma (PC, N.=101) between 2010 and 2022. Clinical outcomes were evaluated using the clinical cure classification proposed by Vorselaars et al., stratified by surgical approach and adrenal pathology. Perioperative parameters and postoperative steroidal replacement were also assessed. RESULTS: Median follow-up was 53.9 months (IQR 31.4-103.1). Rates of clinical cure, clear improvement, and failure were 61.0%, 17.1%, and 21.9% in the MIPA group, and 70.1%, 15.3%, and 14.6% in the MITA group, respectively (all P>0.54). Postoperative steroidal replacement was more common after MITA (19.5% vs. 9.9%, P=0.80). When stratified by pathology, clinical cure was significantly more frequent in PC compared to PA (86.1% vs. 52.3%, P<0.001). Complication rates were low and comparable between groups (P=0.82). CONCLUSIONS: In selected cases, MIPA offers long-term clinical outcomes comparable to MITA, with a lower trend in steroidal replacement. Stratification by pathology confirmed the greater clinical reversibility of PC compared to PA. The clinical cure system proved applicable across disease types and surgical strategies, supporting its broader use as a pragmatic evaluative tool in adrenal surgery.