Percutaneous ablation for adrenal metastases: a systematic review and meta-analysis

Introduction
Imaging-guided percutaneous ablation (PA) is commonly employed for the treatment of patients diagnosed with adrenal metastasis (AM), but comprehensive analyses are essential to validate the efficacy and safety of this approach. Aim: The present meta-analysis was designed to evaluate the safety, efficacy, and long-term outcomes associated with the imaging-guided PA treatment of AM.

Material and methods
Relevant studies in the PubMed, Embase, and Wanfang databases published as of June 2022 were identified, and pooled endpoint analyses were performed with Stata 12.0.

Results
This meta-analysis included 15 studies. Overall, the respective pooled primary technical success, secondary technical success, local hemorrhage, pneumothorax, hypertension crisis, local recurrence, 1-year overall survival (OS), and 3-year OS rates in study participants were 88%, 93%, 3%, 6%, 6%, 19%, 80%, and 46%. High levels of heterogeneity were evident for the 1-year OS (I2 = 79.6%) and 3-year OS endpoints (I2 = 67.1%), but meta-regression analyses failed to identify predictors of these OS rates. Low heterogeneity was observed for subgroups of patients who had undergone cryoablation (I2 = 0%) or patients with multiple primary cancers (I2 = 0%) with respect to 1-year OS. Similarly, low heterogeneity for the 3-year OS endpoint was detected in subgroups of patients who had undergone cryoablation (I2 = 0%), ultrasound-guided PA (I2 = 0%), individuals with AMs secondary to hepatocellular carcinoma (I2 = 0%), and patients with multiple primary cancers (I2 = 0%).

Conclusions
These results suggest imaging-guided PA to be a safe and effective treatment for AM associated with satisfactory long-term patient outcomes.