The surgical strategy for malignant pheochromocytoma must respect the “no touch” or the “as minimal manipulation as possible” principles to avoid hemodynamic instability consequent to catecholamine release. This strategy also prevents tumor effraction and seeding. Minimally invasive surgery with the transabdominal or retroperitoneal posterior approach is validated as the technique of choice. Since regional adrenalectomy and lymphectomy are not required to achieve surgical radicality, minimally invasive surgery can also be employed in the management of overtly malignant tumors. Early arterial ligation should be pursued in order to reduce the risk of intraoperative adrenergic crisis.