Laparoscopic Adrenalectomy for Pheochromocytoma: Twenty-Year Institutional Experience in 64 Consecutive Patients from a Tertiary Center

Abstract Background Long-term single center series remain useful for describing perioperative outcomes after laparoscopic adrenalectomy for Pheochromocytoma (PCC), particularly the clinical impact of intraoperative hemodynamic instability. Methods We retrospectively reviewed all eligible consecutive patients who underwent laparoscopic adrenalectomy for histologically confirmed adrenal pheochromocytoma between January 2003 and December 2024. Patients with non-PCC adrenal disease, extra-adrenal paraganglioma, or lesions requiring upfront surgery for suspected invasion were excluded. Outcomes were analyzed descriptively. Results Among 304 laparoscopic adrenalectomies, 64 patients (21.1%) had adrenal PCC. Mean age was 49.5 years (range, 20–79), 40 patients (62.5%) were female, and mean tumor size was 5.44 cm (range, 3.2–8.2). Conversion occurred in one patient (1.6%). Mean operative time was 100 min, mean blood loss was 120 mL, and no transfusions or 30-day deaths occurred. Thirty-day morbidity was 9.3%, with one Grade IIIa event and no Grade IV/V events. Hypertensive episodes, defined as systolic blood pressure > 180 mmHg, were recorded in 48 patients (75.0%) under continuous arterial monitoring. Hormonal normalization was achieved in 62 patients (96.8%) and blood pressure normalization in 58 (90.6%). During mean follow-up of 46.4 months (range, 4-150), one case of persistent disease and one local recurrence were observed; no distant metastasis or disease-specific death was observed. Conclusion In selected adrenal PCCs, laparoscopic adrenalectomy was associated with low conversion, low morbidity, and high biochemical cure. The high rate of hypertensive episodes reflects the strict threshold used and does not support causal inference regarding morbidity.