Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma.
OBJECTIVE
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.


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.


RESULTS
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).


CONCLUSIONS
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.
Department of Urology, Chung Shan Medical University Hospital, No. 110, Chien-Kuo North Rd., Section 1, Taichung, 402, Taiwan.
Min-Hsin
MH
Yang
Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.
Yeu-Sheng
YS
Tyan
Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Yu-Hui
YH
Huang
Department of Urology, Chung Shan Medical University Hospital, No. 110, Chien-Kuo North Rd., Section 1, Taichung, 402, Taiwan.
Shao-Chuan
SC
Wang
Department of Urology, Chung Shan Medical University Hospital, No. 110, Chien-Kuo North Rd., Section 1, Taichung, 402, Taiwan. cshy650@csh.org.tw.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan. cshy650@csh.org.tw.
Sung-Lang
SL
Chen
D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000096:biosynthesis; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000450:Aldosterone
Ablation; Adrenal; Aldosteronism; Radiofrequency