Partial adrenalectomy in pheochromocytomas offers equal safety compared to total adrenalectomy

Surgery of pheochromocytomas is basically associated with hemodynamic fluctuations. Partial adrenalectomy (PA) is indicated especially for patients with bilateral pheochromocytomas, as it avoids long-term steroid supplementation. However, PA means direct manipulations and transection of pheochromocytoma-bearing tissue which may further accentuate intraoperative hemodynamic changes. A retrospective analysis of 550 operations on pheochromocytoma, performed between January 2006 and December 2024, was conducted. After exclusion of operations performed for unilateral recurrence, metastatic disease, simultaneous bilateral operation, and cases with missing intraoperative data, 240 partial and 178 total adrenalectomies (TA) were included in the analysis. A propensity-score matching was performed based on age, sex, body mass index, tumor size, genetic status, and tumor biochemical profile. Intraoperative hemodynamic parameters were analysed both before and after matching, including the maximal mean arterial pressure, the total intraoperative dose of nitroprusside, and the number of intraoperative episodes in which systolic arterial pressure exceeded 160 mmHg. In the unmatched cohort, patients in the TA group demonstrated a higher maximal systolic pressure (209 [164-250] vs. 178 [144-216]; p < 0.001), a higher total intraoperative nitroprusside dose (4.0 [0.0-8.8] vs. 1.0 [0.0-4.0], p < 0.001), and a higher number of episodes of systolic blood pressure spikes exceeding 160 mmHg (4 [2-5] vs. 2 [1-3]. p < 0.001), compared to the PA group. After the matching, there were no statistically significant differences between the groups in all assessed parameters. Additionally, the influence of the transection of the main adrenal vein on the hemodynamic in the PA group was evaluated. Patients were stratified based on whether the adrenal vein was preserved (n = 112) or transected (n = 128). No significant differences were observed between subgroups. Partial adrenalectomy is not associated with an increased risk of intraoperative hypertensive episodes in patients with pheochromocytoma and represents a safe and viable treatment option.