Surgical resection of pheochromocytoma

There are 3 surgical approaches to remove a pheochromocytoma: 1) open adrenalectomy, 2) laparoscopic adrenalectomy, and 3) cortex-preserving partial adrenalectomy.

The open adrenalectomy used to be the only approach but is now usually reserved for large (>10 cm) tumors. The whole adrenal gland along with the tumor is removed.

Laparoscopic adrenalectomy is the main procedure nowadays and is performed for most patients with pheochromocytoma. Again, the whole adrenal gland along with the tumor is removed.

Cortex-preserving partial adrenalectomy only removes the tumor but preserves the adrenal cortex (at least in theory). It is possible only in some patients. It is appealing to young patients with familial pheochromocytoma. These patients will have multiple pheochromocytomas on both adrenal glands and have to take medications for many many years if they have both adrenal glands removed at a young age.

The most important factors for a successful operation are experienced surgeon and anesthesiologist, and of course, careful preoperative preparation. The specific approach a surgeon adopts is less a factor. The surgeon has to be proficient in the specific approach she/he uses.