Due to the extended variety in localization, the choice of surgical strategy in the treatment of retroperitoneal paragangliomas can be challenging. In this study, we collected and analyzed our experience on a large series of patients.

A total of 111 retroperitoneal paraganglioma operations were performed on 100 patients between January 2000 and December 2023 at our institution. There were 42 female and 58 male patients with a mean age of 39 ± 18. The genetic mutation was known in 62 cases at the time of surgery (VHL - 37, SDH gene mutations - 24, MEN 2B -1). The consecutive data were prospectively collected and retrospectively analyzed.

Out of 111 paraganglioma surgeries, 32 were performed laparoscopically (median operating time: 102 min; range: 37-630), 65 retroperitoneoscopically (69 min; range: 18-510), seven combined laparo-retroperitoneoscopically (340 min; range: 60-630), and seven open (340 min; range: 245-745). The median tumor size for minimally invasive operations was 2.5 cm (range 0.5-9), while for open operations or those with conversion, it was 7 cm (range 2-15). Three conversions to open surgery occurred. Five patients had distant metastasis (four with SDHB and one with VHL mutation). Ten patients underwent more than one operation. Complications included isolated cases of postoperative hematoma, relaxation, and dysaesthesia of the flank. Blood transfusions were needed in two cases. The median hospital stay was 4 days (2-30).

Minimally invasive surgery is the gold standard for paragangliomas; nevertheless, the operation can be challenging and requires extensive experience in laparoscopic surgery.