3D planning of irreversible electroporation treatment in pancreatic carcinoma: a use case

Abstract

The appropriate procedure for closure of the remnant pancreatic stump in distal pancreatectomy (DP) remains unresolved. The purpose of this study was to compare the incidence of pancreatic fistula (PF) among the 3 methods, and to determine the risk factors for PF after DP. Methods: Between July 2009 and December 2016, 66 patients underwent pancreatic stump closure with 1 of 3 methods: the clamp-crushing method (n = 26), ultrasonic scissors (n = 18), and a reinforced stapler (n = 22). Results: There were significant differences in the incidence of PF (clamp-crushing method [38%] vs ultrasonic scissors [61%] vs reinforced stapler [9%], p< 0.001), and in the incidence of postoperative intra-abdominal hemorrhage (clamp-crushing method [0%] vs ultrasonic scissors [17%] vs reinforced stapler [0%] p = 0.047). A multivariate analysis revealed that intraoperative blood loss (605 mL), pancreatic thickness (11 mm), and the stump closure method were independent risk factors for PF after DP (p = 0.03, p = 0.001, p=0.018 respectively). Conclusion: The use of a reinforced stapler for the transection of the pancreas can reduce PF after DP. Intraoperative blood loss (605 mL), pancreatic thickness (11 mm), and the stump closure method remained as independent risk factors for PF after DP.

Computer Assistance in the Minimally Invasive Ablation Treatment of Pancreatic Cancer

“…Due to the complex anatomy with varying patient-specific structures at risk, all MDs argue in favor of a preoperative IRE planning tool, which makes use of imaging data in combination with reconstructed 3D models to verify the feasibility of needle configurations. Most of the pancreas specialists see a need for minimally invasive pancreas IRE (87.5%) as well as for intraoperative needle navigation (100%) (illustrated in Figure 2) [32].…”

Irreversible Electroporation in Pancreatic Cancer

“…A specific solution for IRE treatment of the pancreas has been implemented, which provides the surgeon with the possibility to preoperatively verify the needle placement based on given constraints like parallelism and spacing between the needles [53]. The aim of this novel technique in IRE would be the placement of the needles under live CAS-guidance according to the preoperatively defined plan.…”