Cortical-sparing adrenalectomy for bilateral pheochromocytoma - is it a game worth the candle? Systematic review with meta-analysis comparing total vs partial adrenalectomy in bilateral pheochromocytoma

Zawadzka, Karolina; Tylec, Piotr; Małłczak, Piotr; Major, Piotr; ̧dziwiatr, Michał Pe; Pisarska-Adamczyk, Magdalena

doi:10.1530/endoabs.81.p520

Cited by 2 publications

(1 citation statement)

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“…A systematic review and meta-analysis of 1444 patients with bilateral pheochromocytoma revealed no difference in the development of metastatic pheochromocytoma, overall mortality, and pheochromocytoma-specific mortality between bilateral total and cortical sparing adrenalectomy. However, cortical sparing adrenalectomy had a three-fold lower risk of developing glucocorticoids dependency and a higher risk of recurrence [29 ▪ ]. Therefore, cortical sparing adrenalectomy needs to be discussed with patients at risk of developing bilateral pheochromocytoma taking into account the risk of recurrence and the risk of adrenal insufficiency.…”

Section: Subtotal Adrenalectomymentioning

confidence: 99%

Surgical approaches to the adrenal gland

Sada

McKenzie

2023

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewReview the literature on the surgical management of adrenal diseases, highlighting the various surgical approaches and their respective pros and cons. Recent findingsMinimally invasive adrenalectomy is commonly used for small and benign adrenal tumors, whereas open adrenalectomy is preferred for larger tumors and primary adrenal malignancy. Although minimally invasive adrenalectomy results in shorter recovery and fewer complications compared with open, the latter offers better oncologic outcomes in the setting of primary adrenal malignancy. Adrenalectomy is performed transabdominally or retroperitoneoscopically, both yielding equivalent results and recovery. Traditional laparoscopic or robotic equipment can be utilized for either minimally invasive approach. Subtotal adrenalectomy may be appropriate for patients with genetically associated pheochromocytoma to preserve cortical function and reduce the risk of adrenal insufficiency. However, the potential benefits of sparing adrenal function must be weighed against the risk of recurrence. SummaryAdrenalectomy is becoming increasingly common worldwide. For benign and small adrenal tumors, minimally invasive adrenalectomy is generally considered the standard approach, while open adrenalectomy is preferred for primary adrenal malignancy and larger tumors. Subtotal adrenalectomy may be appropriate for patients with bilateral adrenal pheochromocytoma, as it can reduce the need for lifelong glucocorticoid dependency.

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Section: Subtotal Adrenalectomymentioning

confidence: 99%

Surgical approaches to the adrenal gland

Sada

McKenzie

2023

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Surgical treatment of pheochromocytoma

Shikhmagomedov,

Rebrova,

Krasnov

et al. 2023

Probl Endokrinol (Mosk)

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This review article contains a summary of modern aspects of preoperative preparation, surgical treatment, and follow-up of patients with adrenal pheochromocytomas. The main component of preoperative preparation is the use of alpha-blockers. The need to prescribe them to all patients is increasingly disputed, especially for patients without severe hypertension. An increasing number of publications demonstrate positive results of treatment without the use of alpha-blockers, advocating an individual approach and the use of the drug according to certain indications. Minimally invasive endoscopic techniques of adrenalectomy have become widespread in surgical treatment. They are represented by laparoscopic and retroperitonescopic technic, including using their single-port modifications. The earliest possible intersection of the central vein in the past was considered the most important aspect of adrenalectomy for pheochromocytoma, currently, due to the development of surgical techniques and anesthesiological manuals, this has ceased to be a mandatory rule of successful surgery. Despite the significant influence of the intersection of this vessel on intraoperative hemodynamics, surgical tactics with its later intersection have their own justifications and do not lead to a deterioration in treatment results. The standard volume of surgical intervention for pheochromocytomas is total adrenalectomy, however, in the presence of hereditary syndromes, such as multiple endocrine neoplasia type 2 syndrome, neurofibomatosis type 1, von Hippel-Lindau syndrome, it is possible to perform cortical-sparing adrenalectomy.

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Cortical-sparing adrenalectomy for bilateral pheochromocytoma - is it a game worth the candle? Systematic review with meta-analysis comparing total vs partial adrenalectomy in bilateral pheochromocytoma

Cited by 2 publications

References 0 publications

Surgical approaches to the adrenal gland

Surgical approaches to the adrenal gland

Surgical treatment of pheochromocytoma

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