3:09 PM Abstract No. 333 Treatment approach for percutaneous ablation of metastatic adrenal masses

Abstract

The adrenal gland is a common site of metastasis. Palliative ablation can have a role in tumor debulking for symptom management or offer an alternative to adrenalectomy for poor surgical candidates. The position of the adrenal in the retroperitoneum often requires access across the diaphragm or adjacent organs. This report describes our experience with percutaneous image-guided ablation of adrenal masses and approach for tumor access. HiIQ database was reviewed for cases of adrenal ablation performed August 2002 - August 2017. 19 ablations were performed under CT guidance in 12 patients (7 male, median age 61), of which 11/19 (58%) were right-sided. Cases were reviewed for tumor size, etiology, ablation modality, ablation approach, and complications. Etiologies were lung cancer (7), hepatocellular carcinoma (3), renal cell carcinoma (1), and neuroendocrine tumor (1). Mean adrenal size was 4.4 ± 2.5 cm. Ten of 19 cases (53%) used cryoablation (CA), 3/19 (16%) microwave ablation (MW) and 6/19 (32%) radiofrequency ablation (RF). Mean number of ablation sessions per lesion was 1.3 ± 0.5. Median number of probes was 3 for CA and 1 for RF and MW. Half of CA procedures were performed with conscious sedation. Only 3 cases allowed a direct approach. Alternative approaches included transpleural alone (11/19; 58%) or combination transpleural and transhepatic/transplenic (5/19; 26%). One CA procedure was aborted due to patient syncope, resulting in incomplete ablation. There was one minor complication of self-limited asymptomatic right pneumothorax. Percutaneous image-guided adrenal mass ablation is technically feasible with a low rate of complications. The location of the adrenal gland makes direct access often unfeasible; however, alternate approaches can provide safe treatment windows.