Effectiveness of Non-Medical Treatment on Survival, Perioperative, and Clinical Outcomes in Canine Cushing's Syndrome: A Systematic Review and Network Meta-Analysis.

Cushing's 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 3.99-2985.49) and longer survival time (MD = 624.00 days, 95% CI 227.93-1020.07). Among dogs undergoing adrenalectomies; laparoscopic adrenalectomy was associated with shorter surgical times (MD = -28.38 min, 95% CI -41.39 to -15.38) and hospitalization (MD = -0.66 days, 95% CI -1.00 to -0.32) compared to open adrenalectomy.