title: Partial adrenalectomy: underused first line therapy for small adrenal tumors.
abstract: OBJECTIVE
  Many patients with small adrenal masses undergo total adrenalectomy. We evaluated partial adrenalectomy outcomes by performing a comprehensive literature review.
  
  
  METHODS
  We performed a PubMed search of the English language literature using the queries partial adrenalectomy and adrenal sparing surgery, and identified 317 and 155 articles, respectively. We excluded case reports or series with fewer than 5 patients, articles not focused on surgical management and those that did not indicate perioperative outcomes. The remaining articles were cross-referenced by author and institution to eliminate studies with redundant cases. Demographics, diagnosis, tumor characteristics, perioperative and functional outcomes, and recurrence data were collected when available.
  
  
  RESULTS
  A total of 22 articles from a total of 22 first authors met our inclusion criteria, describing outcomes in a total of 417 patients. There has been an increasing trend toward partial adrenalectomy worldwide in the last 20 years. Partial adrenalectomy is most commonly done for Conn's syndrome, followed by pheochromocytoma. Most procedures are laparoscopic with minimal morbidity. The recurrence rate is only 3% and more than 90% of patients remain steroid independent.
  
  
  CONCLUSIONS
  Partial adrenalectomy surgical outcomes and perioperative complications are similar to those reported for total adrenalectomy. When partial adrenalectomy is done for small adrenal lesions, the malignancy rate is negligible, the recurrence rate is low and most patients remain steroid-free at long-term followup. These data strongly support the acceptance of partial adrenalectomy as first line treatment for small adrenal masses.
authors.affiliation: Urologic Oncology Branch, National Cancer Institute and Section on Neuroendocrinology, National Institute of Child Health and Human Development (BBS, KP), National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Kaye
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Storey
authors.forename: Karel
authors.initials: K
authors.lastname: Pacak
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D006801:Humans; D012008:Recurrence