{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:51:59Z","timestamp":1792547519289,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":32,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical resection is the standard treatment for phaeochromocytoma (PCC). Current guidelines recommend an open approach for large tumours due to the increased risk of complications. This study aimed to characterize surgical outcomes for large (\u2265 6 cm) and small (&amp;lt; 6 cm) PCCs and to identify factors that may improve postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study of patients undergoing adrenalectomy for PCC in 49 international centres between 2012 and 2022 compared patients with tumours &amp;lt; 6\u2005cm in diameter and those with tumours \u2265 6\u2005cm in diameter. Univariate, bivariate (dichotomous), and multivariate (multiple logistic and linear) analyses were used to evaluate outcomes and risk factors for complications. A secondary multivariable analysis evaluated factors, including operative approach, influencing outcomes for patients with tumours \u2265 6\u2005cm. A 1:1 propensity score-matched (PSM) analysis was completed to control for age, sex, body mass index, and the Charlson Co-morbidity Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 2301 patients included in the analysis, 598 (26.0%) had PCCs with a diameter \u2265 6\u2005cm. Patients with tumours \u2265 6\u2005cm had a higher incidence of severe (Clavien\u2013Dindo grade \u2265 IIIa) postoperative complications (11.2% versus 4.8%; P &amp;lt; 0.001). Multivariable analysis revealed that tumour size \u2265 6\u2005cm was an independent predictor of any complications (odds ratio (OR) 1.93; P &amp;lt; 0.001). Subanalysis of patients with tumours \u2265 6\u2005cm demonstrated that laparoscopic (OR 0.33; P &amp;lt; 0.001) and robotic (OR 0.40; P = 0.038) adrenalectomy were independently associated with less morbidity than an open approach. PSM analysis revealed a mean 276.0-ml higher blood loss (95% confidence interval (c.i.) 138.9 to 413.0\u2005ml; P &amp;lt; 0.001) and 2.9-point higher Comprehensive Complication Index (95% c.i. 0.6 to 5.3; P = 0.015) for patients with tumours \u2265 6\u2005cm compared with patients with PCCs &amp;lt; 6\u2005cm in diameter. Optimal cut-off analysis revealed that a tumour diameter of \u2265 5.8\u2005cm was associated with increased complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients undergoing adrenalectomy for PCCs \u2265 6\u2005cm have a higher risk of severe complications than patients with smaller tumours. Despite this increased risk in patients with large (\u2265 6\u2005cm) tumours, minimally invasive surgery was independently associated with a reduced likelihood of complications. This study supports a minimally invasive approach in patients with large PCCs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf133","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T11:47:34Z","timestamp":1758196054000},"source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of the effect of tumour size on outcomes for patients undergoing adrenalectomy for phaeochromocytoma: international multicentre analysis"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0995-6255","authenticated-orcid":false,"given":"Steffane","family":"McLennan","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine & Dentistry , Edmonton, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3110-5238","authenticated-orcid":false,"given":"Kevin","family":"Verhoeff","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine & Dentistry , Edmonton, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5506-224X","authenticated-orcid":false,"given":"Alessandro","family":"Parente","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine & Dentistry , Edmonton, Alberta ,","place":["Canada"]},{"name":"Department of Hepatopancreatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital , Birmingham ,","place":["UK"]},{"name":"Institute of Liver Studies, King\u2019s College Hospital , London ,","place":["UK"]},{"name":"School of Immunology and Microbial Sciences, The Roger Williams Institute of Liver Studies Faculty of Life Sciences and Medicine, , King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alynne","family":"Ribano","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine & Dentistry , Edmonton, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, The First Affiliated Hospital of Jilin University , Changchun ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhicheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, The First Affiliated Hospital of Jilin University , Changchun ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiale","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaorong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"\u015aledzi\u0144ski","sequence":"additional","affiliation":[{"name":"Division of General, Endocrine and Transplant Surgery, Medical University of Gda\u0144sk , Gda\u0144sk ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Hellmann","sequence":"additional","affiliation":[{"name":"Division of General, Endocrine and Transplant Surgery, Medical University of Gda\u0144sk , Gda\u0144sk ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1259-2491","authenticated-orcid":false,"given":"Marco","family":"Raffaelli","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Centro di Ricerca in Chirurgia Endocrina e dell'Obesit\u00e0, Universit\u00e0 Cattolica del Sacro Cuore , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0865-700X","authenticated-orcid":false,"given":"Francesco","family":"Pennestr\u00ec","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Centro di Ricerca in Chirurgia Endocrina e dell'Obesit\u00e0, Universit\u00e0 Cattolica del Sacro Cuore , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Sywak","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J","family":"Papachristos","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District , 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,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Eatock","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Royal Victoria Hospital , Belfast ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Royal Victoria Hospital , Belfast ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6057-4642","authenticated-orcid":false,"given":"Maurizio","family":"Iacobone","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua 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,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Colucci","sequence":"additional","affiliation":[{"name":"Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust , Cambridge ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry V M","family":"Spiers","sequence":"additional","affiliation":[{"name":"Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust , Cambridge ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albertas","family":"Dauk\u0161a","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lithuanian University of Health Sciences , Kaunas ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-6748","authenticated-orcid":false,"given":"Ozer","family":"Makay","sequence":"additional","affiliation":[{"name":"Centre of Endocrine Surgery, Ozel Saglik Hospital , Izmir ,","place":["T\u00fcrkiye"]},{"name":"School of Medicine, Aristoteleio University of Thessaloniki , Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yigit","family":"Turk","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital , Izmir ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafize Basut","family":"Atalay","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital , Izmir 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,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Waghorn","sequence":"additional","affiliation":[{"name":"Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust , Liverpool ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust , Liverpool ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu","family":"Mihai","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust , Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabapathy P","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"Department of General 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,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3739-6048","authenticated-orcid":false,"given":"Helen","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, University Hospital Wales , Cardiff ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnathan","family":"Hubbard","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, St Thomas\u2019 Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4622-9508","authenticated-orcid":false,"given":"Cristina","family":"Lamas","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete , Albacete ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Mercer","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit, Department of General Surgery, Christchurch Hospital , Christchurch ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"MacPherson","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Christchurch Hospital , Christchurch ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supanut","family":"Lumbiganon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Urology, Khon Kaen University , Khon Kaen ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Calatayud","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Hospital Universitario 12 de Octubre , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia Alexandra","family":"Hanzu","sequence":"additional","affiliation":[{"name":"Endocrinology, Hospital Clinic University Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Vidal","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Hospital Clinic Barcelona, Universitat de Barcelona, IDIBAPS , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Araujo-Castro","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Universitario Ram\u00f3n y Cajal , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar","family":"Minguez Ojeda","sequence":"additional","affiliation":[{"name":"Urology Department, Hospital Universitario Ram\u00f3n y Cajal , Madrid 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