Surgical outcomes of partial adrenalectomy for pheochromocytoma: A systematic review and meta-analysis

The purpose of our study was to evaluate the efficacy and safety of partial adrenalectomy (PA) in the management of pheochromocytomas. A systematic review and metanalyses of all randomized controlled trials and observational studies (comparative and non-comparative studies), including case series with at least 5 cases, reporting efficacy and safety outcomes of PA in the treatment of bilateral and/or inherited pheochromocytomas was performed. A total of 33 articles were included in this systematic review, including 22 observational comparative and 11 single-arm studies. The pooled rates of biochemical and clinical cure after PA were 99.7% (95%CI: 98.7-100) and 99.8% (95%CI: 98.8-100), respectively. The pooled complication rate was 5.9% (95%CI: 0.8-10.9). Tumor recurrence and metastatic rates were 4% (95%CI: 0-1.6) and 0% (95%CI: 0.00-0.6), respectively. Steroid supplementation was required in 7.6% (95%CI: 2.8-12.5) of patients. No significant difference was detected in acute adrenal crisis (odds ratio [OR] 0.44, 95%CI: 0.16-1.22), biochemical (OR 0.42, 95%CI: 0.05-3.85) and clinical cure (OR 0.42, 95%CI: 0.05-3.85), complication (OR 1.59, 95%CI: 0.28-9.13) and metastatic rate (OR 1.56, 95%CI: 0.59-4.15) between the group of partial and total adrenalectomy. Nevertheless, recurrence rate (OR 2.55, 95%CI: 1.24-5.23) was higher with PA, while the need for supplementation rate (OR 0.01, 95%CI: 0.00-0.01) was significantly lower than in the total adrenalectomy group. The conclusion of the study is that the probability of biochemical cure and the rate of complications is similar between the group of patients who underwent total and partial adrenalectomy, but PA is associated with a lower rate of adrenal insufficiency and a higher recurrence rate than total adrenalectomy.