Retroperitoneoscopic-guided cool-tip radiofrequency ablation of adrenocortical aldosteronoma

To analyze the feasibility, safety, and therapeutic effects of retroperitoneoscopic-guided cool-tip radiofrequency ablation (RCRFA) used for the treatment of adrenocortical aldosteronoma.

We performed a retrospective comparison of RCRFA (n=12) and laparoscopic partial adrenalectomy (LPA) (n=26) in the patients with solitary aldosterone-producing adenoma in our center from 2006 to 2009. Intraoperative and follow-up data were reviewed for clinical parameters and hormone levels. Univariate analysis was performed to measure the consistency of these clinical parameters preoperatively and postoperatively.

All patients presented hypertension, hypokalemia, and high aldosterone/renin ratio (ARR>30) preoperatively and were finally histologically confirmed as aldosteronoma. Technical success rate of these two procedures was 100%. Every patient was followed up for more than 3 years (mean 49.2±15.6 months). There was no evidence of residual or recurrent lesion postoperatively. ARR declined significantly postoperatively compared with preoperatively (54.33±24.90 vs 5.50±3.30 in the RCRFA group and 51.45±29.12 vs 6.67±3.75 in the LPA group, p<0.05). Hypokalemia was resolved in all patients after the surgery. A majority of patients (91.7% in the RCRFA group and 96.2% in the LPA group) were cured without any further need of antihypertensive medication or experienced an improvement in hypertension. Antihypertensive medications reduced significantly after surgical procedures. RCRFA and LPA demonstrated similar therapeutic effects. Compared with LPA, RCRFA provided a shorter operative time (65.6±13.5 minutes vs 86.0±16.5 minutes in LPA, p<0.05), less blood loss (20.0±11.3 mL vs 60.8±52.0 mL in LPA, p<0.05), and lower complication rate (16.7% vs 26.9% in LPA).

RCRFA might be an alternative for LPA in selected patients with adrenocortical aldosteronoma. Due to limited sample size, more experience is necessary to validate this procedure.