Introduction: UPA is the most common surgically curable form of endocrine hypertension. The underlying cause of resistant hypertension after surgery remains controversial. The aim of this study was to identify preoperative factors predictive of complete clinical success after laparoscopic adrenalectomy for UPA. Methods: Between 2000 and 2021 patients treated by laparoscopic adrenalectomy for UPA were enrolled in this retrospective study. Preoperative data were divided into 3 categories: clinical, biological and radiological variables and follow up data was recorded. For determining factors influencing surgical outcome patients were divided into 3 groups : 1) complete clinical success (CS): normal blood pressure(BP) (=140/90 mmHg) without antihypertensive medications (AHM). 2) Partial CS: the same BP as before surgery with less AHM or a reduction in BP with either the same amount or less AHM. 3) Absent CS: unchanged or increased BP with either the same amount or an increase in AHM. We performed an univariate and multivariate regression analysis. Statistical significance was defined as a P value of < 0.05. Results: Our study included 71 patients (59% female, mean age 46 years, median follow up 21 months). The mean duration of hypertension before surgery was 82.9 ± 75.9 months. Preoperative mean DDD was 2.8 ± 1.1 with 66% of patients having poorly controlled hypertension. Retroperitoneoscopic adrenalectomy was performed in 47 patients (66%). Four patients (6%) underwent partial adrenalectomy. Only 2 patients required conversion to open adrenalectomy. Complication rate (Clavien-Dindo =3a) was 4%. No mortality was registered. After adrenalectomy complete plus partial CS occured in 64 patients (91%). The following factors were associated with a complete clinical success by univariate analysis: absence of diabetes (p=0.007), low BMI (p=0.001), lower levels of preoperative AHM (p=0.01), controlled preoperative BP (p=0.024), higher levels of plasma aldosterone-to-renin ratio (ARR) (p=0.001), adenoma classification (p < 0.001) and aldosteronoma resolution score (ARS) (p=0.002). Multivariate regression analysis revealed that the main determinants of complete clinical success were: absence of diabetes (OR: 5.205, 95% CI 1.411-19.206), low BMI (OR:0.904, 95% CI 0.820-0.997), plasma ARR > 332 (OR: 1.003, 95% CI 1.001-1.004) and ARS score = 3 (OR: 2.056, 95% CI 1.210-3.491). Conclusions: The majority of our patients (91%) experienced clinical benefit from adrenalectomy.The main determinants of cured hypertension were absence of diabetes, low BMI, high levels of plasma ARR and high ARS score. SOURCE OF Funding: None
