Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma
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To retrospectively compare the safety and efficacy of radiofrequency ablation (RFA) with laparoscopic adrenalectomy (LA) in treating aldosterone-producing adenoma (APA) of the adrenal gland.
Materials and methods
From September 2009 to September 2013, seven patients, diagnosed with unilateral adrenal APA and underwent computed tomography (CT)-guided percutaneous RFA, were recruited in this retrospective study. Eighteen unilateral adrenal APA with the same tumor size (<25 mm) who underwent LA during the same interval were enrolled as control group. Treatment success was defined as complete tumor ablation on follow-up CT scan and normalization of serum aldosterone-to-renin ratio. We also compared “normalization ability” between RFA group and LA group. Normalization ability was defined as reduction in blood pressure, decrease in number of antihypertensive medicine use, reduction in serum aldosterone, and increase in serum potassium level.
There was no statistically significant demographic difference in both groups. The mean tumor size was 18 (8–25) mm in RFA and 19 (11–25) mm in LA groups, respectively. There was only one intra-procedure hypertensive crisis in the RFA group. No other complications needed further management in both groups. During an interval of 3–6 months of follow-up, the treatment success rate reached 100 % in the RFA group versus 94.4 % in the LA group. Normalization ability was statistically equivalent in the RFA and the LA group. Comparing with LA group, RFA group demonstrated with less post-operative pain (visual analog scale, 2.0 ± 1.16 vs. 4.22 ± 1.44, p < 0.001) and shorter operative time (105 ± 34 vs. 194 ± 58 min, p < 0.001).
CT-guided percutaneous RFA is effective, safe and is a justifiable alternative for patients who are reluctant or unfit for laparoscopic surgery for the treatment of APA.
KeywordsAldosteronism Adrenal Radiofrequency Ablation
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
This article does not contain animals performed by any of the authors.
- 6.Carrafiello G, Lagana D, Recaldini C, Giorgianni A, Ianniello A, Lumia D, D’Ambrosio A, Petulla M, Dionigi G, Fugazzola C (2008) Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device. Cardiovasc Interv Radiol 31(4):762–767. doi: 10.1007/s00270-008-9337-1 CrossRefGoogle Scholar
- 13.Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF Jr, Montori VM, Endocrine S (2008) Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93(9):3266–3281. doi: 10.1210/jc.2008-0104 CrossRefPubMedGoogle Scholar
- 14.Lencioni R, Goletti O, Armillotta N, Paolicchi A, Moretti M, Cioni D, Donati F, Cicorelli A, Ricci S, Carrai M, Conte PF, Cavina E, Bartolozzi C (1998) Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial. Eur Radiol 8(7):1205–1211. doi: 10.1007/s003300050536 CrossRefPubMedGoogle Scholar
- 15.Arima K, Yamakado K, Suzuki R, Matsuura H, Nakatsuka A, Takeda K, Sugimura Y (2007) Image-guided radiofrequency ablation for adrenocortical adenoma with Cushing syndrome: outcomes after mean follow-up of 33 months. Urology 70(3):407–411. doi: 10.1016/j.urology.2007.04.032 CrossRefPubMedGoogle Scholar
- 17.Orlacchio A, Bolacchi F, Chegai F, Bergamini A, Costanzo E, Del Giudice C, Angelico M, Simonetti G (2014) Comparative evaluation of percutaneous laser and radiofrequency ablation in patients with HCC smaller than 4 cm. Radiol Med (Torino) 119(5):298–308. doi: 10.1007/s11547-013-0339-y CrossRefGoogle Scholar
- 24.Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT Jr, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235(3):728–739. doi: 10.1148/radiol.2353042205 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.van Eekeren RR, Boersma D, Konijn V, de Vries JP, Reijnen MM (2013) Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins. J Vasc Surg 57(2):445–450. doi: 10.1016/j.jvs.2012.07.049 CrossRefPubMedGoogle Scholar
- 32.Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, Crudo V, Burrello J, Milan A, Rabbia F, Veglio F (2013) Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 98(12):4826–4833. doi: 10.1210/jc.2013-2805 CrossRefPubMedGoogle Scholar