Successful Laparoscopic Resection of a Giant Para-aortic Pheochromocytoma: A Case Report

Paragangliomas are rare neuroendocrine tumors that may be functional or non-functional and are typically located in the adrenal or extra-adrenal regions. Surgical resection remains the cornerstone of management, with open surgery generally recommended for large tumors due to anatomical complexity. We report the case of a 51-year-old South Asian man with a non-functional retroperitoneal paraganglioma measuring 9 × 6 × 5.4 cm, located para-aortically from L2 to L4. Despite its size and proximity to critical vascular structures, the tumor was successfully excised laparoscopically. Preoperative imaging included computed tomography (CT), gallium-68 DOTATATE positron emission tomography-CT (PET-CT), and iodine-131 metaiodobenzylguanidine (I-131 MIBG) scintigraphy, all supporting the diagnosis. Histopathology confirmed paraganglioma with vascular invasion and a Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) score of 6/10. The patient had no classical symptoms of catecholamine excess and recovered well postoperatively. This case demonstrates that, with careful planning and experienced surgical expertise, even large para-aortic paragangliomas can be safely managed laparoscopically, challenging traditional preferences for open surgery in such cases.