{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:56:01Z","timestamp":1780325761650,"version":"3.54.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Bilateral pheochromocytomas are rare and often heritable. Total adrenalectomy leads to a definitive oncological cure, with subsequent definitive hypocortisolism. Subtotal adrenalectomy is a possible alternative. The aim of this study was to assess the effects of total adrenalectomy and subtotal adrenalectomy on bilateral pheochromocytoma in terms of post-surgical rate of recurrence, metastatic disease, and steroid dependence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Systematic searches in the bibliographic databases PubMed, Embase, and Europe PMC were performed for 1945 to 1 June 2023. PRISMA guidelines were followed and the PICO strategy was applied to English-language studies comparing subtotal adrenalectomy with total adrenalectomy. A random-effects model was used to assess the different outcomes for studies with high heterogeneity. The Newcastle\u2013Ottawa scale and the Risk Of Bias In Non-randomized Studies of Interventions (\u2018ROBINS-I\u2019) tool were used to assess quality and risk of bias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From a total of 12 909 studies, 1202 patients (from 10 retrospective studies) were eligible for the meta-analysis. In six studies, including 1176 patients, the recurrence rate after subtotal adrenalectomy and total adrenalectomy was 14.1 versus 2.6 per cent respectively (OR 4.91, 95 per cent c.i. 1.30 to 18.54; P = 0.020; I2 72 per cent). In nine studies, including 1124 patients, the rate of post-surgical steroid dependence was 93.3 versus 11.6 per cent after total adrenalectomy and subtotal adrenalectomy respectively (OR 0.003, 95 per cent c.i. 0.0003 to 0.03; P &amp;lt; 0.00001; I2 66 per cent). Based on two studies, including 719 patients, no differences were evident regarding the occurrence of post-surgery metastatic disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Subtotal adrenalectomy leads to less post-surgical primary adrenal insufficiency, but leads to a higher postoperative recurrence rate. Future prospective randomized studies, with clear eligibility criteria, are needed to confirm these results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrad109","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T01:41:15Z","timestamp":1699580475000},"source":"Crossref","is-referenced-by-count":6,"title":["Total adrenalectomy <i>versus<\/i> subtotal adrenalectomy for bilateral pheochromocytoma: meta-analysis"],"prefix":"10.1093","volume":"7","author":[{"given":"Donatella","family":"Schiavone","sequence":"first","affiliation":[{"name":"Department of Medicine-DIMED, University of Padua , Padua , Italy"},{"name":"Division of General Surgery, AULSS 6 Hospital \u2018Madre Teresa di Calcutta\u2019 , Monselice , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Ballo","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padua , Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Filardo","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padua , Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Dughiero","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padua , Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Torresan","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padua , Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7963-0931","authenticated-orcid":false,"given":"Gian 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