Comparison of postoperative biochemical indicators and surgical result between partial adrenalectomy and total adrenalectomy: a systematic review and meta-analysis

Abstract

Background: The selection and extent of application for both total adrenalectomy (TA) and partial adrenalectomy (PA) within this surgical approach continue to be matters of debate. This paper compares the postoperative efficacy and functional indicators of PA and TA to provide comprehensive insights for clinicians to consider the best surgical treatment options.

Methods: Systematic review on PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) was conducted. We compared several key factors between TA and PA, including operating time (OT), blood loss, length of hospital stay, serum aldosterone levels, plasma renin activity, postoperative aldosterone to renin ratio (ARR), systolic and diastolic blood pressure, early postoperative complications, and blood potassium concentration. Data were collected by the Cochran-Mantel-Haenszel method, and Review Manager software (RevMan) version 5.3 was used.

Results: The results showed that compared to TA, PA had a shorter OT [weighted mean difference (WMD) =-12.16; 95% confidence interval (CI): -19.42, -4.89; I²=96%; P=0.001]. Compared with PA, TA had a better recovery of diastolic blood pressure (WMD =2.12; 95% CI: 0.42, 3.81; I²=0%; P=0.01). Regarding serum aldosterone, plasma renin activity, postoperative ARR, systolic blood pressure, early postoperative complications, length of hospital stay, and blood potassium, there was no significant difference between PA and TA (P>0.05). In subgroup analysis, results indicated that there was currently no significant difference in most results between PA and TA (P>0.05). For patients aged 50 years or younger, PA had a shorter OT compared to TA (WMD =-19.71; 95% CI: -35.99, -3.42; I²=95%; P=0.02). For tumor size ≤2.0 cm, the intraoperative blood loss of PA was greater than that of TA (WMD =16.76; 95% CI: 3.62, 29.90; I²=37%; P=0.01).

Conclusions: The OT was shorter in PA than in TA, and shorter in younger patients. The recovery of diastolic blood pressure after TA was better than that of PA. When the tumor was 2 cm or small, TA had less blood loss than PA. There was no significant difference in functional indexes between PA and TA. PA offers advantages in surgical outcomes compared to TA. However, for tumors ≤2 cm, TA may provide greater benefits to patients. Additionally, TA demonstrates superior recovery of diastolic blood pressure compared to PA according to functional indicators.

Keywords: Partial adrenalectomy (PA); adrenal glands; complications; outcome; total adrenalectomy (TA).

Figure 1

Funnel plot. SE, standard error; MD, mean difference.

Figure 2

Screening process. CNKI, China National Knowledge Infrastructure.

Figure 3

Surgical results and functional indicators. (A) PA vs. TA: operation time. (B) PA vs. TA: blood loss. (C) PA vs. TA: hospital stay. (D) PA vs. TA: diastolic blood pressure. (E) PA vs. TA: systolic blood pressure. (F) PA vs. TA: serum aldosterone. (G) PA vs. TA: potassium. (H) PA vs. TA: plasma renin activity. (I) PA vs. TA: ARR. (J) PA vs. TA: early complication. PA, partial adrenalectomy; TA, total adrenalectomy; SD, standard deviation; IV, inverse variance; CI, confidence interval; M-H, Mantel-Haenszel; ARR, aldosterone to renin ratio.

Figure 4

Subgroup result. (A) PA vs. TA: operation time. (B) PA vs. TA: blood loss. (C) PA vs. TA: Conn’s vs. mixed. Mixed: included pheochromocytoma, Cushing or Conn’s disease. PA, partial adrenalectomy; TA, total adrenalectomy; SD, standard deviation; IV, inverse variance; CI, confidence interval.