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

  • Urology - Original Paper
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Abstract

Purpose

The 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 (1975–2016) 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 cancer-specific 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.

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Availability of data and material

Publicly available dataset.

Code availability

Available on reasonable request to authors.

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Funding

This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.

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Authors and Affiliations

  1. Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Hriday P. Bhambhvani & Dylan J. Peterson

  2. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Michael A. Daneshvar & Mark W. Ball

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  1. Hriday P. Bhambhvani
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  2. Michael A. Daneshvar
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  3. Dylan J. Peterson
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Correspondence to Hriday P. Bhambhvani.

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Bhambhvani, H.P., Daneshvar, M.A., Peterson, D.J. et al. Partial versus total adrenalectomy for pheochromocytoma: a population-based comparison of outcomes. Int Urol Nephrol 53, 2485–2492 (2021). https://doi.org/10.1007/s11255-021-03004-4

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  • DOI: https://doi.org/10.1007/s11255-021-03004-4

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