{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:29:40Z","timestamp":1785770980006,"version":"3.56.0"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vet. Sci.","Veterinary Sciences"],"abstract":"<jats:p>Cushing\u2019s syndrome is a common endocrine disorder in dogs managed with both medical and non-medical treatments; however, the effects of non-medical interventions on survival, perioperative, and clinical outcomes remain uncertain. A comprehensive search was conducted across MEDLINE, Embase, Web of Science, Academic Search Complete, and the Cochrane Library databases. Five studies (n = 248 dogs) met the inclusion criteria. Three studies evaluated laparoscopic and open adrenalectomy in dogs with adrenal-dependent hypercortisolism, whereas two studies evaluated radiotherapy in dogs with pituitary-dependent hypercortisolism. Meta-analysis demonstrated no significant differences in the survival rates between laparoscopic and open adrenalectomy at 12, 24, or 36 months. Fractionated radiotherapy improved survival rates at 12 months, while both fractionated and stereotactic radiotherapy improved survival rates at 24 months. This benefit, however, was not maintained at 36 months. Radiotherapy was also associated with improved neurologic outcomes (OR = 109.17, 95% CI 3.99\u20132985.49) and longer survival time (MD = 624.00 days, 95% CI 227.93\u20131020.07). Among dogs undergoing adrenalectomies; laparoscopic adrenalectomy was associated with shorter surgical times (MD = \u221228.38 min, 95% CI \u221241.39 to \u221215.38) and hospitalization (MD = \u22120.66 days, 95% CI \u22121.00 to \u22120.32) compared to open adrenalectomy.<\/jats:p>","DOI":"10.3390\/vetsci13080771","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:16:27Z","timestamp":1785766587000},"page":"771","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Non-Medical Treatment on Survival, Perioperative, and Clinical Outcomes in Canine Cushing\u2019s Syndrome: A Systematic Review and Network Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Sophia","family":"Shanlly","sequence":"first","affiliation":[{"name":"Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Slessor","sequence":"additional","affiliation":[{"name":"Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2848-6659","authenticated-orcid":false,"given":"Wenting","family":"Yan","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva D. C.","family":"Rosaasen-Uwiera","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2416-5024","authenticated-orcid":false,"given":"Jessica J. D.","family":"Thorlakson","sequence":"additional","affiliation":[{"name":"Cameron Science and Engineering Library, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather L.","family":"Bruce","sequence":"additional","affiliation":[{"name":"Department of Animal Science and Aquaculture, Dalhousie University, Truro, NS B2N 5E3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard R. E.","family":"Uwiera","sequence":"additional","affiliation":[{"name":"Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Niessen, S.J.M., Behrend, E.N., Fracassi, F., Church, D.B., Foster, S.F., Galac, S., Melian, C., P\u00f6ppl, \u00c1.G., Ramsey, I.K., and Sieber-Ruckstuhl, N.S. (2025). Agreeing Language in Veterinary Endocrinology (ALIVE): Cushing\u2019s Syndrome and Hypoadrenocorticism-A Modified Delphi-Method-Based System to Create Consensus Definitions. Vet. Sci., 12.","DOI":"10.3390\/vetsci12080761"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"318","DOI":"10.3171\/jns.1964.21.4.0318","article-title":"The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations (Pituitary Basophilism)","volume":"21","author":"Cushing","year":"1964","journal-title":"J. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/jsap.12523","article-title":"Epidemiology of Hyperadrenocorticism among 210,824 Dogs Attending Primary-Care Veterinary Practices in the UK from 2009 to 2014: Hyperadrenocorticism in Dogs","volume":"57","author":"Scudder","year":"2016","journal-title":"J. Small Anim. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1354\/vp.41-5-490","article-title":"Indicators of Malignancy of Canine Adrenocortical Tumors: Histopathology and Proliferation Index","volume":"41","author":"Labelle","year":"2004","journal-title":"Vet. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1111\/jvim.12192","article-title":"Diagnosis of Spontaneous Canine Hyperadrenocorticism: 2012 ACVIM Consensus Statement (Small Animal)","volume":"27","author":"Behrend","year":"2013","journal-title":"J. Vet. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0195-5616(01)50010-8","article-title":"Medical Treatment of Canine Pituitary-Dependent Hyperadrenocorticism (Cushing\u2019s Disease)","volume":"31","author":"Peterson","year":"2001","journal-title":"Vet. Clin. N. Am. Small Anim. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1210\/jc.2012-3126","article-title":"Medical Treatment of Cushing\u2019s Disease","volume":"98","author":"Feelders","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.2460\/javma.233.12.1896","article-title":"Use of Ketoconazole to Treat Dogs with Pituitary-Dependent Hyperadrenocorticism: 48 Cases (1994\u20132007)","volume":"233","author":"Lien","year":"2008","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.rvsc.2022.06.020","article-title":"Assessment of Selegiline and Trilostane Combined Therapy Efficacy for Canine Pituitary-Dependent Hypercortisolism Treatment: A Pilot Randomized Clinical Trial","volume":"150","author":"Meirelles","year":"2022","journal-title":"Res. Vet. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/j.1939-1676.1999.tb02184.x","article-title":"The Efficacy of L-Deprenyl in Dogs with Pituitary-Dependent Hyperadrenocorticism","volume":"13","author":"Reusch","year":"1999","journal-title":"J. Vet. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/j.1748-5827.2002.tb00038.x","article-title":"Use of Aminoglutethimide in the Treatment of Pituitary-Dependent Hyperadrenocorticism in the Dog","volume":"43","author":"Guerrero","year":"2002","journal-title":"J. Small Anim. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Shanlly, S., Slessor, J., Yan, W., Thorlakson, J.J.D., Bruce, H.L., and Uwiera, R.R.E. (2025). Effectiveness of Medical Treatment on Survivability in Canine Cushing\u2019s Syndrome: A Systematic Review and Meta-Analysis. Animals, 15.","DOI":"10.3390\/ani15202954"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.2460\/javma.242.12.1715","article-title":"Evaluation of Risk Factors for Outcome Associated with Adrenal Gland Tumors with or without Invasion of the Caudal Vena Cava and Treated via Adrenalectomy in Dogs: 86 Cases (1993\u20132009)","volume":"242","author":"Barrera","year":"2013","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1532-950X.1997.tb01502.x","article-title":"Transsphenoidal Hypophysectomy in Beagle Dogs: Evaluation of a Microsurgical Technique","volume":"26","author":"Meij","year":"1997","journal-title":"Vet. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"602","DOI":"10.2460\/javma.254.5.602","article-title":"Outcomes and Adverse Effects Associated with Stereotactic Body Radiation Therapy in Dogs with Nasal Tumors: 28 Cases (2011\u20132016)","volume":"254","author":"Mayer","year":"2019","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the Sample Mean and Standard Deviation from the Sample Size, Median, Range and\/or Interquartile Range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Deeks, J.J., Higgins, J.P.T., Altman, D.G., and On behalf of the Cochrane Statistical Methods Group (2019). Analysing Data and Undertaking Meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions, Wiley.","DOI":"10.1002\/9781119536604.ch10"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chaimani, A., Caldwell, D.M., Li, T., Higgins, J., and Salanti, G. (2019). Undertaking Network Meta-Analyses. Cochrane Handbook for Systematic Reviews of Interventions, Wiley.","DOI":"10.1002\/9781119536604.ch11"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1002\/jrsm.1037","article-title":"Indirect and Mixed-Treatment Comparison, Network, or Multiple-Treatments Meta-Analysis: Many Names, Many Benefits, Many Concerns for the next Generation Evidence Synthesis Tool","volume":"3","author":"Salanti","year":"2012","journal-title":"Res. Synth. Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/S0895-4356(00)00242-0","article-title":"Publication and Related Bias in Meta-Analysis: Power of Statistical Tests and Prevalence in the Literature","volume":"53","author":"Sterne","year":"2000","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/vco.12991","article-title":"Outcomes of Stereotactic Radiation Therapy versus Fractionated Radiation Therapy in 44 Dogs with Pituitary Masses: A Multi-Institutional Retrospective Study (2016\u20132022)","volume":"22","author":"Gieger","year":"2024","journal-title":"Vet. Comp. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1111\/j.1939-1676.2007.tb03060.x","article-title":"Survival, Neurologic Response, and Prognostic Factors in Dogs with Pituitary Masses Treated with Radiation Therapy and Untreated Dogs","volume":"21","author":"Kent","year":"2007","journal-title":"J. Vet. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.2460\/javma.245.9.1028","article-title":"Comparison of Perioperative Morbidity and Mortality Rates in Dogs with Noninvasive Adrenocortical Masses Undergoing Laparoscopic versus Open Adrenalectomy","volume":"245","author":"Mayhew","year":"2014","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"O99","DOI":"10.1111\/vsu.13565","article-title":"A Comparison of Outcomes between Laparoscopic and Open Adrenalectomies in Dogs","volume":"50","author":"Taylor","year":"2021","journal-title":"Vet. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"van Bokhorst, K.L., Galac, S., Kooistra, H.S., de Grauw, J.C., Teske, E., Grinwis, G.C.M., and van Nimwegen, S.A. (2023). Laparoscopic vs. Open Adrenalectomy: Perioperative Data and Survival Analysis in 70 Dogs with an Adrenal Tumor. Front. Vet. Sci., 10.","DOI":"10.3389\/fvets.2023.1156801"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4314\/ovj.v9i1.5","article-title":"Cushing\u2019s Syndrome-an Epidemiological Study Based on a Canine Population of 21,281 Dogs","volume":"9","author":"Carotenuto","year":"2019","journal-title":"Open Vet. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/avj.13416","article-title":"Patient Signalment and Aetiology of Hypercortisolism in Australian Dogs with Cushing\u2019s Syndrome","volume":"103","author":"Langner","year":"2025","journal-title":"Aust. Vet. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1111\/vsu.13221","article-title":"Perioperative Morbidity and Mortality in Dogs with Invasive Adrenal Neoplasms Treated by Adrenalectomy and Cavotomy","volume":"48","author":"Mayhew","year":"2019","journal-title":"Vet. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.jvs.2016.01.055","article-title":"Transperitoneal versus Retroperitoneal Approach for Open Abdominal Aortic Aneurysm Repair in the Targeted Vascular National Surgical Quality Improvement Program","volume":"64","author":"Buck","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Liptak, J.M., Buracco, P., Culp, W.T.N., and Bacon, N.J. (2025). Color Atlas of Canine and Feline Surgical Oncology, John Wiley & Sons. [1st ed.].","DOI":"10.1002\/9781119630791"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"216","DOI":"10.2460\/javma.239.2.216","article-title":"Adrenalectomy in Dogs with Adrenal Gland Tumors: 52 Cases (2002-2008)","volume":"239","author":"Massari","year":"2011","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2460\/javma.23.03.0135","article-title":"Laparoscopic Adrenalectomy for Resection of Unilateral Noninvasive Adrenal Masses in Dogs Is Associated with Excellent Outcomes in Experienced Centers","volume":"261","author":"Mayhew","year":"2023","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1245\/s10434-013-3164-6","article-title":"Long-Term Survival after Adrenalectomy for Stage I\/II Adrenocortical Carcinoma (ACC): A Retrospective Comparative Cohort Study of Laparoscopic versus Open Approach","volume":"21","author":"Donatini","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"41","DOI":"10.5455\/medarh.2021.75.41-44","article-title":"Laparoscopic versus Open Adrenalectomy: A Retrospective Comparative Study","volume":"75","author":"Zarour","year":"2021","journal-title":"Med. Arch."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1111\/jvim.16724","article-title":"Effect of Pituitary-Dependent Hypercortisolism on the Survival of Dogs Treated with Radiotherapy for Pituitary Macroadenomas","volume":"37","author":"Rapastella","year":"2023","journal-title":"J. Vet. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.eururo.2010.06.024","article-title":"Laparoscopic versus Open Adrenalectomy for Adrenocortical Carcinoma: Surgical and Oncologic Outcome in 152 Patients","volume":"58","author":"Brix","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/vru.12708","article-title":"Long-Term Survival with Stereotactic Radiotherapy for Imaging-Diagnosed Pituitary Tumors in Dogs","volume":"60","author":"Hansen","year":"2019","journal-title":"Vet. Radiol. Ultrasound"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e70141","DOI":"10.1111\/vru.70141","article-title":"Tolerability and Efficacy Following Definitive-Intent Fractionated Radiotherapy for Canine Pituitary Tumors","volume":"67","author":"Caeiro","year":"2026","journal-title":"Vet. Radiol. Ultrasound"},{"key":"ref_39","first-page":"i58","article-title":"Stereotactic Radiosurgery and Fractionated Radiation Therapy in the Management of Pituitary Tumors","volume":"7","author":"Mantziaris","year":"2025","journal-title":"Neurooncol. Adv."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jns.2016.11.024","article-title":"Safety and Efficacy of Fractionated Stereotactic Radiotherapy and Stereotactic Radiosurgery for Treatment of Pituitary Adenomas: A Systematic Review and Meta-Analysis","volume":"372","author":"Li","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.rvsc.2018.01.001","article-title":"Pituitary Size Alteration and Adverse Effects of Radiation Therapy Performed in 9 Dogs with Pituitary-Dependent Hypercortisolism","volume":"118","author":"Sawada","year":"2018","journal-title":"Res. Vet. Sci."}],"container-title":["Veterinary Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-7381\/13\/8\/771\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:38:37Z","timestamp":1785767917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-7381\/13\/8\/771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["vetsci13080771"],"URL":"https:\/\/doi.org\/10.3390\/vetsci13080771","relation":{},"ISSN":["2306-7381"],"issn-type":[{"value":"2306-7381","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}