Evaluation of differences in presentation and postoperative outcomes after adrenalectomy for pheochromocytoma according to age

Objective: Pheochromocytoma is increasingly diagnosed at the extremes of age due to the availability of genetic screening in young patients and incidental detection on imaging in older patients. The aim of this study was to assess the effect of age on presentation and outcomes after adrenalectomy for pheochromocytoma. Methods: A retrospective international multicenter cohort study was performed on patients undergoing adrenalectomy for pheochromocytoma between 2012 and 2022 in 49 centers. Patients were divided into three cohorts: ≤40, 41-59, and ≥60 years old. Univariate and multivariate analyses were used to compare cohorts and assess the impact of age on postoperative outcomes. Results: Of the 2,301 included patients, 551 were ≤40 years (23.9%), 969 were between 41 and 59 years (42.1%), and 781 were ≥60 years (33.9%). Younger cohorts were more likely to have a genetic syndrome (≤40 years 29.4% vs 41-59 years 11.5% vs ≥60 years 6.2%, P < 0.001) and bilateral tumors (10.2 vs 2.3 vs 1.3%, P < 0.001). On multivariable analysis, overall complications seemed less frequent in older cohorts (adjusted odds ratio (aOR): 0.64, P = 0.012, and aOR: 0.66, P = 0.054, for 41-59 and ≥60 years versus ≤40 years), while there were no clear trends in severe complications (Clavien-Dindo grade 3a-5) (aOR: 0.81, P = 0.481, and aOR: 0.78, P = 0.486, respectively) or comprehensive complication index (beta coefficient: -1.49, P = 0.046, and -1.66, P = 0.083, respectively). Conclusion: Age is associated with significant differences in presentation in patients undergoing adrenalectomy for pheochromocytoma, but does not have a clear association with postoperative complications. Pheochromocytoma postoperative morbidity is more likely affected by 'high-risk' disease rather than exclusively by age.