Objective To compare the therapeutic effects of simultaneous resection and staged resection of bilateral adrenal pheochromocytomas. Methods Clinical data of 43 patients whose bilateral adrenal pheochromocytomas were surgically treated was analyzed retrospectively. Patients were divided into the simultaneous resection group (bilateral adrenal pheochromocytomas were simultaneously resected, n=23) and staged resection group (bilateral adrenal pheochromocytomas were resected in stages, n=20) according to different surgical procedures. Baseline characteristics and testing results of perioperative and postoperative indexes of the two groups were compared. Results All patients of the simultaneous resection group underwent open surgeries. For the staged resection group, 16 patients underwent open surgeries for both pheochromocytomas; 2 patients underwent open surgeries for one pheochromocytoma and laparoscopic operations for the other pheochromocytoma; and 2 patients underwent laparoscopic operations for both pheochromocytomas. The operative time, volumes of blood loss, incidences of intraoperative significant fluctuation of blood pressure, incidences of postoperative transient adrenocortical insufficiency, postoperative hospitalization time, left tumor sizes, and right tumor sizes of patients undergone open surgeries of the simultaneous resection group and staged resection group were 3.66 h and 2.11 h (P<0.05), 1 680 mL and 276.92 mL (P＜0.05), 52.17% and 18.67% (P＜0.05), 82.61% and 44.44% (P<0.05), 12.07 d and 10.41 d (P>0.05), 4.32 cm and 5.64 cm (P>0.05), 5.10 cm and 4.01 cm (P>0.05), respectively. The average follow-up time of two groups was 9.3 years (from 4 months to 27 years). The recurrences of the simultaneous resection group and staged resection group were 26.1% (6 cases) and 15% (3 cases). Conclusion Compared to the simultaneous resection, the staged resection of bilateral adrenal pheochromocytomas shows higher perioperative safety, shorter postoperative convalescence, less complications, and lower recurrence and may be an ideal surgical procedure for patients with bilateral adrenal pheochromocytomas, especially for patients with high risk.