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Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging is recommended in patients with metastatic pheochromocytoma (PC) and paraganglioma (PGL). There are no data on whether routine preoperative 18F-FDG PET/CT in all patients with PC/PGL impacts surgical management.The aim of this study was to determine whether routine preoperative 18F-FDG PET/CT imaging affects the surgical management of patients with PC/PGLs.We analyzed clinical, biochemical, genetic, and anatomic imaging data in 93 consecutive patients with PC/PGL who collectively underwent a total of 100 operations and who had preoperative 18F-FDG PET/CT imaging.Of 100 operations, preoperative 18F-FDG PET/CT showed additional lesions compared to anatomic imaging in 15 cases. These patients were more likely to undergo an open surgical approach (P < 0.05). Presence of genetic mutation, redo operations, sex, age, or tumor size had no significant association with finding additional lesions on 18F-FDG PET/CT.Additional lesions detected on preoperative 18F-FDG-PET/CT imaging have an impact on the surgical approach in patients with PC/PGLs. Therefore, surgeons should routinely obtain 18F-FDG-PET/CT imaging in patients with PC/PGL to allow for a more precise surgical intervention.