Intraoperative adverse events during irreversible electroporation–a call for caution

Kambakamba, Patryk; Bonvini, John M.; Glenck, Michael; López, Liliana Castrezana; Pfammatter, Thomas; Clavien, Pierre‐Alain; DeOliveira, Michelle L.

doi:10.1016/j.amjsurg.2016.07.001

Cited by 15 publications

(13 citation statements)

References 25 publications

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“…It has also been shown that subclinical myocardial injury can occur with IRE as evidenced by elevations in high-sensitive troponin I [18]. Cardiac arrhythmias rarely impair completion of an IRE procedure, as was the case in our three instances of atrial fibrillation which were all either self-limiting or medically managed [19]. Ablation of large tumour volumes (40% of liver) has been shown in an animal model to induce alterations in serum potassium levels due to ionic shifts with nanopore formation resulting in the potential for electrocardiogram arrhythmias, but this mechanism is not felt to be applicable in this study as lesional volume was considerably smaller [20].…”

Section: Discussionmentioning

confidence: 68%

Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

Mafeld

Wong

Kibriya

et al. 2018

Cardiovasc Intervent Radiol

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Aim Irreversible electroporation (IRE) is a non-thermal ablative option in patients unsuitable for standard thermal ablation, due to its potential to preserve collagenous structures (vessels and ducts) and a reduced susceptibility to heat sink effects. In this series from two large tertiary referral hepatobiliary centres, we aim to assess the safety/outcomes of hepatic IRE. Materials and Methods Bi-institutional retrospective, longitudinal follow-up series of IRE for primary hepatic malignancy; [hepatocellular carcinoma ( n = 20), cholangiocarcinoma ( n = 3)] and secondary metastatic disease; colorectal ( n = 28), neuroendocrine ( n = 1), pancreatic ( n = 1), breast ( n = 1), gastrointestinal stromal tumour (GIST, n = 1) and malignant thymoma ( n = 1). Outcome measures included procedural safety/effectiveness, time to progression and time to death. Results Between 2013 and 2017, 52 patients underwent percutaneous IRE of 59 liver tumours in 53 sessions. All tumours were deemed unsuitable for thermal ablation. Cases were performed using ultrasound (US) or computed tomography (CT) guidance. A complete ablation was achieved in n = 44, (75%) of cases with an overall complication rate of 17% ( n = 9). Of the complete ablation group, median time to progression was 8 months. At 12 months, 44% were progression-free (95% CI 30–66%). The data suggest that larger lesion size (> 2 cm) is associated with shorter time to progression and there is highly significant difference with faster time to progression in mCRC compared with HCC. Median survival time was 38 months. Conclusion This bi-institutional review is the largest UK series of IRE and suggests this ablative technology can be a useful tool, but appears to mainly induce local tumour control rather than cure with HCC having better outcomes than mCRC.

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Section: Discussionmentioning

confidence: 68%

Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

Mafeld

Wong

Kibriya

et al. 2018

Cardiovasc Intervent Radiol

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“…Of 38 relevant studies selected based on the title and abstracts screened, the full-text version of 4 studies was finally reviewed. These studies comprised 1 study based on a porcine model (16) and 3 studies on human patients (17)(18)(19). Table IV provides the basic characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

Irreversible electroporation ablation of end‑stage metastatic retroperitoneal lesions: Report on three cases and literature review

et al. 2019

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Metastatic retroperitoneal tumors constitute an end-stage disease with poor prognosis that represents a heavy global health burden. The present study aimed to explore the efficacy of irreversible electroporation ablation (IRE) therapy in patients with end-stage retroperitoneal tumors. Between April 2016 and September 2017, three patients with unresectable retroperitoneal malignant tumors were enrolled. Among these cases, ultrasound (US)-guided IRE was palliatively performed for targeting 3 tumors (1 tumor per patient) located around the abdominal aorta. Post-treatment contrast-enhanced US (CEUS) and contrast-enhanced computed tomography (CECT) scans were subsequently performed to evaluate the area adjacent to the ablation zone and determine the prognosis. During the follow-up, the cases experienced a reduction of pain (mean score of 5.8 decreased to 2.2, based on the visual analogue scale), and had an overall survival rate ranging from 2 to 11 months. Case 1 remained alive at the time of submission of this study, but case 2 died within 2 months and case 3 within 11 months due to liver metastases of the primary tumor. At the 3-week follow-up, the CEUS image for case 1 exhibited a contrast defect with a sufficient ablation margin, in accordance with the CECT at 1.5 months following IRE, exhibiting complete tumor necrosis without contrast enhancement. Overall, these results suggest that US-guided percutaneous IRE may be effective in the treatment of end-stage retroperitoneal tumors. However, further studies are required to substantiate the conclusions of the present study. The present clinical trial was registered at clinicaltrials.gov (ID: NCT02822066) on June 20th, 2016.

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“…In the treatment of abdominal tumors, various ablation methods have been reported to cause intraoperative hypertension, such as radiofrequency ablation, 1 cryoablation 2 and irreversible electroporation (IRE). 3 Hypertension caused by thermal or cryoablation was usually caused by direct ablation of adrenal lesions. 4 As the adrenal gland appeared normal at the end of the IRE procedure and on follow-up computed tomography (CT) scans, the patient's biochemistry profile showed no abnormality in adrenal function, and it is therefore generally overlooked as the cause of intraoperative hypertension.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 The use of general anesthesia, neuromuscular blockade, and an electrocardiogram synchronization device is necessary for IRE, because the current ablation device needs to be in diastole to discharge ablation. 3 Standard use of the device requires the patient's heart rate to be between 55 and 105 beats, as there will be discharge if the heart rate is too slow or too fast. Anesthesiologists often face the following difficulties in controlling intraoperative blood pressure and heart rate.…”

Section: Introductionmentioning

confidence: 99%

“…9 Third, procedural severe hypertension often occurs during the operation for reasons unknownsometimes accompanied by arrhythmia or cardiovascular and cerebrovascular accidents. 3 If antihypertensive drugs are used prophylactically, many patients will have bradycardia and cause machine shutdown; however, if not used in advance, patients with hypertension will be prone to a high risk of cardiovascular and cerebrovascular accidents. To confirm that injury to the adrenal gland is the cause of the severe intraprocedural hypertension, data of 366 patients who received IRE treatment in our hospital were reviewed from July 1, 2015, to June 30, 2018, determining the causes of and solutions for intraoperative hypertension.…”

Section: Introductionmentioning

confidence: 99%

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<p>Prevention of Procedural Hypertension in the Irreversible Electroporation Ablation of Liver and Pancreatic Tumors Based on Distance from the Adrenal Gland</p>

Fang¹,

Niu²,

Chen³

2020

CMAR

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Background and objective: When irreversible electroporation (IRE) ablation of abdominal tumors, procedural hypertension often occurs, which often affects the progress of the ablation. Until now, there is no reasonable explanation for this phenomenon. The objective of this research was to explore the cause and solution of procedural hypertension in percutaneous IRE. Methods: In this study, the treatment data of 4 consecutive groups of patients were used to confirm the cause of intraoperative hypertension and then verify the solution. A total of 155 patients with procedural hypertension were screened based on their medical records of pancreatic or hepatic IRE treatment. Procedural hypertension was monitored in 21 new patients, the correlation between serum catecholamines and hypertension was recorded and evaluated using regression analysis. Forty new patients were divided into two groups (distance from needle tip to adrenal gland, < 2 cm vs ≥ 2 cm), and the blood pressure was recorded and compared with two-way ANOVA. Eleven patients with ablative distance <2 cm were treated in advance with phentolamine to observe for the occurrence of procedural hypertension. Results: Of the 21 re-enrolled patients with ablation of the pancreas and liver tumors, 9 developed intraoperative hypertension with significantly elevated serum catecholamines levels, epinephrine, norepinephrine and dopamine are all positively associated with hypertension, with P values were 0.0003, 0.0253, and 0.0015, respectively. For the two groups with different needle-insertion distances, hypertension in the < 2 cm group was more significant than that in the other group (for procedural hypertension, P< 0.01; for heart rate, P< 0.05), which was considered as a high-risk group. The occurrence of intraoperative hypertension could be completely prevented by using phentolamine prior to treatment. Conclusion: Hypertension occurs frequently during hepatic and pancreatic IRE because of the damage of adrenal gland. The safe distance of ablation probe for the adrenal gland was 2 cm. For high-risk patients, early drug prevention works well.

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Intraoperative adverse events during irreversible electroporation–a call for caution

Cited by 15 publications

References 25 publications

Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

Irreversible electroporation ablation of end‑stage metastatic retroperitoneal lesions: Report on three cases and literature review

<p>Prevention of Procedural Hypertension in the Irreversible Electroporation Ablation of Liver and Pancreatic Tumors Based on Distance from the Adrenal Gland</p>

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