Needlescopic ablation of small adrenal masses.

Needlescopic adrenal ablative therapy is an attractive therapeutic option for the management of small adrenal masses. The spectrum of neoplasms that can be ablated includes isolated solid organ metastases (lung, kidney, liver), nonisolated but symptomatic (painful) adrenal metastasis, and small, nonmetastatic, hormonally active adrenal tumors. Moreover, needlescopic ablation offers an effective minimally morbid intervention for patients who are poor surgical candidates either due to advanced age and/or significant comorbid conditions. Ablative techniques described to date include radiofrequency ablation (RFA), cryoablation, and chemical ablation. Most procedures can be performed under percutaneous radiographic guidance on an outpatient basis. By and large, the bulk of clinical experience with adrenal ablation pertains to RFA. Successful ablation is usually dependent upon lesion size, with tumors 5 cm or smaller demonstrating the highest successful ablation rates. The most frequently described adverse sequelae of adrenal ablation are local tumor recurrences. However, many of these local recurrences can be managed by repeat ablation, with patients demonstrating durable oncologic outcomes.