Changes in the Surgical Management of Pheochromocytoma

Abstract

Surgical management of pheochromocytoma has evolved from a high-risk, open procedure to a nuanced, minimally invasive practice guided by multidisciplinary care. This review synthesizes contemporary advances in diagnostics, genetics, perioperative medicine, and surgical techniques. Definitive treatment remains complete resection, with minimally invasive adrenalectomy (transabdominal or retroperitoneal, laparoscopic, or robotic) now the standard for localized tumors, offering comparable oncologic outcomes when selected based on tumor size, anatomy, and expertise. Genomic characterization is integral to management, as approximately 40% of cases harbor germline mutations, influencing imaging strategies and surgical planning, particularly in advocating for cortical-sparing adrenalectomy in hereditary settings to avoid lifelong steroid dependence. Despite technical progress, perioperative hemodynamic crisis remains a key concern. While the necessity of universal preoperative α-adrenergic blockade is debated for low-risk patients, it remains the guideline-backed standard to mitigate cardiovascular morbidity. For metastatic disease, surgery retains a role within a multimodal framework, offering symptomatic and potential survival benefit in select cases. Future directions will further integrate molecular profiling, advanced imaging, and surgical innovation to optimize long-term oncologic and functional outcomes.