Surgery for pheochromocytoma

Adrenalectomy for pheochromocytoma may be performed via an open incision or via a minimally invasive approach and may involve removing the entire adrenal gland or partially resecting the adrenal gland. In the current era, minimally invasive adrenalectomy is most commonly performed and may be performed via the laparoscopic transperitoneal or retroperitoneoscopic approaches. Open adrenalectomy is reserved for large tumors or those with invasion into surrounding structures requiring en bloc resection. Open surgery may also be necessary for resection of a recurrent pheochromocytoma in a previously dissected area. Important considerations to optimize patient outcomes include genetic testing, appropriate preoperative alpha- and beta-blockade, intraoperative hemodynamic monitoring and central venous access, and close communication between the surgical and anesthesia teams, particularly at the time of ligation of the main adrenal vein. The technique of adrenalectomy via various approaches is described. Partial (also known as subtotal, cortical-sparing, or adrenal-sparing) adrenalectomy is advocated for patients with some hereditary pheochromocytomas in order to potentially avoid lifelong steroid hormone dependence. Successful use of this technique is dependent on pheochromocytoma location within the adrenal gland, number of pheochromocytomas present in the same adrenal gland, and size of the pheochromocytoma. Adrenal gland remnants are at risk of developing recurrent pheochromocytoma.