In the management of unilateral adrenal tumors, total adrenalectomy (TA) has been considered as standard approach. However, TA leads to adrenal insufficiency requiring corticosteroid replacement therapy which may cause complications, such as adrenal crisis, Cushing syndrome, obesity, immunodeficiency, and cardiovascular disease. Then, partial adrenalectomy (PA) was adopted to preserve residual adrenal function and minimize the need for lifelong corticosteroid therapy. In unilateral adrenal tumor, higher recurrence rates with PA needs to be considered compared to TA. Given the variability in outcomes, a systematic review is needed to compare the outcome of PA and TA, specifically in patients with unilateral adrenal tumors.

We searched literature through PubMed, EMBASE, and Cochrane Library from inception to March 2025. We used specific keywords, such as “partial adrenalectomy”, “total adrenalectomy”, and “unilateral adrenal tumor”. Two authors independently screened studies, extracted data, and assessed risk of bias using ROBINS-I. The primary outcomes included operative time, blood loss, and hospital stay. Secondary outcomes were overall complication, hypertension, hypokalemia, and local recurrence. Data were analyzed using a random-effect model.

A total of 5 studies involving 538 patients with unilateral adrenal tumor (adrenal adenoma, adrenal pheochromocytoma, adrenal hyperplasia, and other pathologies) were included. Partial adrenalectomy resulted in a significant reduction in blood loss (MD -9.14 ml; 95% CI −16.99 to −1.29; I² = 24%; p = 0,02) and hospital stay (MD -0.65 days; 95% CI −1.02 to −0.27; I² = 0%; p = 0,0008). However, operative time was significantly shorter in TA (MD 3,02 minute; 95% CI 1,38 to 4,66; I² = 93%; p = 0,0003). There was no statistical significance in overall complications, postoperative hypertension and hypokalemia, also recurrence between TA and PA.

Partial adrenalectomy is associated with less blood loss, shorter hospital stay, but longer operative time compared to total adrenalectomy in patients with unilateral adrenal tumors. Some outcomes had high heterogeneity and wide confidence interval; therefore, these findings should be interpreted with caution.