Background The recent experience of a specialist endocrine surgery uni
t in the management of phaeochromocytoma is reviewed. Methods Over a 1
4-year period (June 1978 to June 1992) 43 patients (14 men, 29 women)
with a mean age of 42 years were referred with phaeochromocytoma. Resu
lts Biochemical confirmation was usually by measurement of 24-h urinar
y vallinylmandelic acid. From 1980 venous sampling was replaced by com
puted tomography as the primary localizing procedure. I-131-meta-iodob
enzylguanidine scintigraphy was used in all patients between 1984 and
1987, but selectively after that. With regard to the operative approac
h used, between 1978 and 1983 midline or flank incisions were used, an
d from 1984 to 1992 subcostal or posterior approaches were used predom
inantly. There was one operative (30-day) death. One patient died 24 m
onths after operation from recurrent malignant phaeochromocytoma, and
three patients died during follow-up from unrelated causes. The remain
ing patients (mean follow-up 30 months) have no evidence of recurrent
phaeochromocytoma, although four remain on antihypertensive medication
. Conclusion Improved imaging of phaeochromocytoma obviates the need f
or transperitoneal exploration, allowing selected phaeochromocytomas t
o be successfully managed using an extraperitoneal approach.