Background Total adrenalectomy (TA) is the standard approach for the management of unilateral adrenal tumors. However, TA leads to adrenal insufficiency requiring corticosteroid replacement therapy, which may cause complications such as adrenal crisis, Cushing syndrome, obesity, immunodeficiency, and cardiovascular disease. Partial adrenalectomy (PA) was then performed to preserve residual adrenal function and minimize the need for lifelong corticosteroid therapy. In unilateral adrenal tumors, higher recurrence rates with PA than with TA need to be considered. Given the variability in outcomes, a systematic review is needed to compare the outcomes of PA and TA in patients with unilateral adrenal tumors. Methods We searched the literature using PubMed, EMBASE, and the Cochrane Library from inception to March 2025. We used specific keywords, such as “partial adrenalectomy,” “total adrenalectomy,” and “unilateral adrenal tumor.” Three authors independently screened the studies, extracted data, and assessed the risk of bias using the ROBINS-I. The primary outcomes included the operative time, blood loss, and hospital stay. The secondary outcomes were overall complications, hypertension, hypokalemia, and local recurrence. Results Eight studies involving 982 patients with unilateral adrenal tumors (adrenal adenoma, adrenal pheochromocytoma, adrenal hyperplasia, and other pathologies) were included. Partial adrenalectomy resulted in a significant reduction in hospital stay (mean difference (MD) -0.49 days; 95% CI −0.78 to −0.21; I 2 = 0%; p = 0,0006). There were no statistically significant differences in operative time, blood loss, overall complications, postoperative hypertension and hypokalemia, or recurrence between the TA and PA. Conclusions Partial adrenalectomy is associated with a shorter hospital stay than total adrenalectomy in patients with unilateral adrenal tumors. Some outcomes showed high heterogeneity and wide confidence intervals; therefore, these findings should be interpreted with caution. PROSPERO Registration : CRD420251024942 (registered on 02/04/2025)
Alvarino et al. (Fri,) studied this question.