Background: Pheochromocytoma and paraganglioma (PPGL) are rare catecholamine-secreting neuroendocrine tumors associated with substantial cardiovascular morbidity and potentially life-threatening complications if left untreated. Surgical resection remains the only curative treatment. Advances in functional imaging, genetic stratification, and minimally invasive surgical techniques have significantly refined contemporary management strategies.

Objective: To summarize current principles of precision surgical management in PPGL and to present institutional experience from a tertiary referral center.

Methods: This study combines a focused literature review with a retrospective analysis of seven consecutive patients who underwent adrenalectomy for pheochromocytoma at a tertiary referral center between 2023 and 2025. Preoperative assessment, genetic evaluation, surgical approach, perioperative outcomes, and follow-up data (10–12 months) were analyzed descriptively.

Results: Modern cross-sectional and functional imaging enabled accurate tumor localization and individualized operative planning. Germline genetic testing informed the extent of adrenal resection, particularly in hereditary syndromes such as multiple endocrine neoplasia type 2 and von Hippel–Lindau disease. All patients underwent minimally invasive unilateral adrenalectomy. One patient experienced an intraoperative hypertensive crisis, which was successfully managed. The median tumor size was 5.2 cm. No postoperative complications or perioperative mortality were observed. Favorable clinical outcomes were maintained during a median follow-up of 11 months, with no evidence of local recurrence or metastatic progression.

Conclusion: Precision-based surgical management integrating advanced imaging, biochemical profiling, and genetic stratification enables safe and effective treatment of PPGL. Even in small-volume series, a structured multidisciplinary approach can achieve excellent perioperative outcomes while preserving adrenal function when appropriate.