Partial versus total adrenalectomy for pheochromocytoma: a population-based comparison of outcomes

Abstract

PurposeThe literature assessing outcomes of partial adrenalectomy (PA) among patients with pheochromocytoma patients is largely limited to isolated, single-institution series. We aimed to perform a population-level comparison of outcomes between patients undergoing PA versus those undergoing total adrenalectomy (TA). Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify adults with pheochromocytoma who underwent either PA or TA. Survival was assessed using multivariable Cox proportional hazards regression, Fine and Gray competing-risks regression, propensity score matching, Kaplan-Meier analysis, and cumulative incidence plots. Results 286 patients (PA: 101, TA: 185) were included in this study. As compared to those undergoing TA, patients undergoing PA had fewer tumors ≥ 8 cm in size (28.7% versus 42.7%, p = 0.048) and were more likely to have localized disease (61.4% versus 44.3%, p = 0.01). In multivariable analysis, patients undergoing PA demonstrated similar all-cause mortality (HR = 0.71, 95% CI 0.44-1.14, p = 0.16) and cancer-specific mortality (HR = 0.64, 95% CI 0.35-1.17, p = 0.15) compared to those who underwent TA. Following 1:1 propensity score matching, Kaplan-Meier analysis revealed no difference in overall survival between PA and TA groups (p = 0.26) nor was there a difference in the cumulative incidence of cancerspecific mortality (p = 0.29). Conclusions In this first population-level comparison of outcomes among patients with pheochromocytoma undergoing PA and those undergoing TA, we found no long-term differences in any survival metric between groups. PA circumvents the need for lifelong corticoid replacement therapy and remains a promising option for patients with bilateral or recurrent pheochromocytoma.

Retroperitoneal laparoscopic partial adrenalectomy (RLPA) for 20-40 mm nonfunctional adrenal tumors in the day surgery mode

“…From that standing ground, researchers shifted their focus on whether or not preserving the healthy adrenal tissue when resecting an adrenal tumor. Not surprisingly, preservation of normal functional adrenal tissue significantly reduced the risk of postoperative adrenal insufficiency ( 6 , 16 ). To date, retroperitoneal laparoscopic partial adrenalectomy (RLPA) for benign lesions was accepted by the majority.…”

“…Retroperitoneal laparoscopic adrenalectomy (RLA) is currently the first-line choice to remove benign adrenal tumors ( 4 , 5 ). However, a growing number of researchers believe that for small (20-40 mm) adrenal tumors, it is preferable to preserve some healthy adrenal tissue in the aim of lowering the risk of postoperative adrenal insufficiency ( 6 , 7 ).…”

Outcome of Partial Adrenalectomy in MEN2 Syndrome: Personal Experience and Systematic Review of Literature

“…MEN2A and MEN2B represent 95% and 5% of all MEN2, respectively, with a similar penetrance of PHEO in both syndromes (about 50% of cases) [ 16 , 21 , 24 ]. Moreover, bilateral clinical presentation may occur in 3%–25% of all patients and in 50–60% of MEN2-patients [ 2 , 3 , 17 , 21 , 25 , 26 , 27 , 28 ]. Bilateral MEN2-PHEOs development is more frequently metachronous rather than synchronous.…”

Construction and validation of a prognostic model for predicting overall survival of primary adrenal malignant tumor patients: A population-based study with 1,080 patients

“…Adrenalectomy is the mainstay treatment (16). For PHEO, total adrenalectomy seems to be more recommended in the guidelines, but partial resection has not been discontinued, either (17)(18)(19). Mitotane is the only oral drug officially approved for ACC (20,21).…”