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Intraoperative and Percutaneous Radiofrequency Ablation of Pheochromocytomas
Yee Lee Cheah1, Jack M Monchik2, William W Mayo-Smith3, Damian E Dupuy3
1Department of Surgery, Rhode Island Hospital, Providence, RI;2Division of Endocrine Surgery, Department of Surgery, Rhode Island Hospital, Providence, RI;3Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI
Objective: To report our experience with percutaneous and intraoperative radiofrequency (RF) ablation of adrenal pheochromocytomas.
Design: Case series
Setting: Tertiary care academic medical center
Patients: Three patients with adrenal pheochromocytoma diagnosed by clinical presentation, adrenal mass on abdominal computed tomography (CT) and elevated urinary and plasma metanephrines. All patients were male (average age, 65 years; range, 61-68 years); average adrenal mass diameter was 2.5cm (range, 2-3.3 cm).
Intervention: Two patients who were high-risk surgical candidates due to multiple medical comorbidities underwent percutaneous RF ablation with an internally cooled cluster electrode. Average number of RF applications per adrenal mass was 3.5 (range, 2-5 applications); average treatment time was 36.5 minutes (range, 22-51 minutes). Another patient had an operative resection of a right-sided recurrent pheochromocytoma and an intraoperative ablation of his left adrenal mass so as to preserve some adrenal function and avoid the difficulty associated with surgical access on the left. He received one ablation with a single tip electrode; treatment time was 4 minutes. All ablations were performed in the presence of an anesthesiologist with experience in the intraoperative management of patients undergoing resections for pheochromocytomas.
Results: Average follow-up was 13.6 months (range, 5-24 months). All lesions were treated successfully with one session of RF ablation. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT images and resolution of the biochemical abnormality. One patient developed hypertension requiring treatment with antihypertensive medication during the percutaneous RF application. There were no major complications.
Conclusions: These cases illustrates that RF ablation may be a safe and effective minimally invasive method to destroy adrenal pheochromocytoma in patients who are deemed poor operative candidates.
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