A Single-institution Experience with Open Irreversible Electroporation for Locally Advanced Pancreatic Carcinoma

Abstract

Background:Locally advanced pancreatic carcinoma (LAPC) is characterized by poor prognosis despite recommended concurrent chemoradiotherapy. Irreversible electroporation (IRE) has emerged as a potential option for the management of unresectable pancreatic cancer. This study was conducted to evaluate the safety and short-term efficacy of open IRE for the treatment of LAPC.Methods:Retrospective data of 25 consecutive patients receiving IRE for T3 lesions from July 2015 to June 2016 at a single center were analyzed. The perioperative and long-term IRE-related complications were reviewed to evaluate the safety of the procedure. The tumor reduction and biological response were analyzed through computed tomography/magnetic resonance imaging; the serum level of CA19-9 was measured as a secondary endpoint to evaluate the short-term efficacy of IRE.Results:All patients were successfully treated; the median tumor size was 4.2 cm and the median IRE time was 36 min. Four intraoperative procedure-related complications were observed (16%): two transient hypertensive episodes, one hypotension case, and one transient supraventricular tachycardia case. Nine postoperative complications were described, including three Grade A pancreatic fistulas, three delayed gastric emptying, one acute pancreatitis, one upper gastrointestinal hemorrhage, and one portal vein thrombosis. The overall rate of stable disease was 28%, 36% achieved partial response, and lower serum CA19-9 levels were recorded in all patients at discharge.Conclusions:IRE is feasible for the treatment of LAPC and is a reasonable intervention strategy owing to its combined attributes of safety and efficacy.

Mesenteric Vessel Patency Following HIFU Therapy in Patients with Locally Invasive Pancreatic Cancer

“…These have relatively high complication rates. In one study with 25 patients, there were three reported pancreatic fistulas, one upper gastrointestinal tract bleed, and one portal vein thrombosis [21], while a case study reported one acute superior mesenteric artery occlusion [22].…”

Effects of high‑intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer

“…Portal vein thrombosis is the most common vascular-associated complication of pancreatic cancer following RFA and IRE treatment (8,9,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). In related studies, patients with pancreatic cancer received RFA and IRE and the primary complications included acute pancreatitis (8,9,(42)(43)(44)(45)(46)48), abdominal pain (46,48), pancreatic fistula (8,9,42,43,45,49), duodenal ulcer or perforation (9,(42)(43)(44)49), gastrointestinal bleeding (42,(44)(45)(46)(47) and biliary fistula (46). In HIFU, the main complications included acute pancreatitis, skin burn, abdominal pain (22,33,34) and elevated amylase expression levels (14,21,33,34), whe...…”

Locally Advanced Pancreatic Cancer: A Review of Local Ablative Therapies

“…Fourteen single arm studies were published regarding IRE for LAPC, either as margin accentuation [ 67 , 68 , 69 , 70 ] or as primary tumor treatment [ 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ]. Patients were treated percutaneously [ 69 , 71 , 72 , 73 , 74 , 75 , 77 , 80 ], laparoscopically [ 70 ], or during laparotomy [ 68 , 69 , 70 , 72 , 73 , 76 , 78 , 79 ]. After a median follow-up of 1–29 months, the median OS from diagnosis ranged between 15.3 and 27.0 months [ 68 , 70 , 74 , 75 , 76 , 77 , 78 ], whilst the median OS from IRE varied between 7.0 months and 14.2 months [ 67 , 73 , 74 , 75 , 77 , 81 ].…”