Partial adrenalectomy: when, where, and how? Considerations on technical aspect and indications to surgery

Background: Partial (or sub-total) adrenalectomy, first proposed for the treatment of hereditary, bilateral pheochromocytoma in order to preserve adrenocortical function and avoid lifelong steroid replacement therapy, has been adopted more recently in case of sporadic, monolateral tumors, like functioning adenomas or pheochromocytomas, in order to minimize the risk of potential adrenal failure, especially in young patients. Methods: Based on a literature review and personal experience, the authors critically review this surgical procedure. Results: The authors discuss surgical approach and indication for partial adrenalectomy, and focus on technical aspects and clinico-pathologic results. Conclusions: Because of the rarity of adrenal tumors and the consequent lack of consistent series, many issues such as correct surgical indications and technical aspects (management of the main adrenal vein, section margins, hemostasis of the adrenal stump, and surgical and functional results) still need to be debated.