Irreversible Electroporation in Pancreatic Cancer

Eigl, Benjamin; Erdem, Suna; Gloor, Beat; Worni, Mathias

doi:10.5772/intechopen.75737

Cited by 3 publications

(8 citation statements)

References 59 publications

(71 reference statements)

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“…In the case of tumor involvement of the portal vein/superior mesenteric vein or superior mesenteric artery, vessel resection, and reconstruction either with anastomosis or graft interposition were performed. Irreversible electroporation (IRE) was used for margin accentuation in patients with a borderline resectable disease to the hepatic artery, celiac trunk, or superior mesenteric artery [ 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

The Impact of Patient Age ≥80 Years on Postoperative Outcomes and Treatment Costs Following Pancreatic Surgery

Ανδρέου

Aeschbacher

Candinas

et al. 2021

JCM

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As life expectancy is increasing, elderly patients are evaluated more frequently for resection of benign or malignant pancreatic lesions. However, the impact of age on postoperative morbidity, mortality, and treatment costs in octogenarian patients (≥80 years) undergoing major pancreatic surgery needs further investigation. The clinicopathological data of patients who underwent pancreatic surgery between January 2015 and March 2019 in a major hepatopancreatobiliary center in Switzerland were assessed. Postoperative outcomes and hospital costs of octogenarians and younger patients were compared in univariate and multivariate regression analysis. During the study period, 346 patients underwent pancreatic resection. Pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, and other procedures were performed in 54%, 20%, 13%, and 13% of patients, respectively. The major postoperative morbidity rate and postoperative mortality rate were 25% and 3.5%, respectively. A total of 39 patients (11%) were ≥80 years old, and 307 patients were <80 years old. The majority of octogenarians suffered from ductal adenocarcinoma, whereas among younger patients, other indications for a pancreatic resection were predominant (ductal adenocarcinoma 64% vs. 41%, p = 0.006). Age ≥80 was associated with more frequent postoperative medical (pulmonary, cardiovascular) and surgical (high-grade pancreatic fistula, postoperative hemorrhage) complications. Postoperative mortality was significantly higher in octogenarians (15.4% vs. 2%, p < 0.0001). This finding may be explained by the higher rate of type C pancreatic fistula (13% vs. 5%), resulting more frequently in postoperative hemorrhage (18% vs. 5%, p = 0.002) among patients ≥80 years old. In the multivariate logistic regression analysis, patient age ≥80 years predicted postoperative mortality independently of the tumor entity and surgical technique (p = 0.013, OR 6.71, 95% CI [1.5–30.3]). Increased major postoperative morbidity was responsible for lower cost recovery in octogenarians (94% vs. 102%, p = 0.046). In conclusion, patient age ≥80 years is associated with increased postoperative medical and surgical morbidity after major pancreatic surgery leading to lower cost recovery and a lower chance for successful resuscitation in patients requiring revisional surgery for postoperative hemorrhage and/or pancreatic fistula. In octogenarian patients suffering from pancreatic tumors, careful selection, and thorough prehabilitation is crucial to achieve the best postoperative and long-term oncologic outcomes.

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Section: Methodsmentioning

confidence: 99%

The Impact of Patient Age ≥80 Years on Postoperative Outcomes and Treatment Costs Following Pancreatic Surgery

Ανδρέου

Aeschbacher

Candinas

et al. 2021

JCM

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“…These nanopores allow for the disruption of intracellular homeostasis and ultimately results in a controlled apoptosis of the target cells (Figure 3). [38][39][40][41] The primary indication and research focus of IRE is the treatment of non-metastatic locally advanced pancreatic cancer (LAPC). The current standard of care for LAPC includes chemotherapy with stereotactic body or external beam radiation therapy.…”

Section: Irreversible Electroporationmentioning

confidence: 99%

“…Thermal ablation techniques were associated with high mortality and morbidity. 38 The biggest advantage of IRE compared to these other ablative techniques is that it preserves the extracellular matrix therefore preserving the pancreatic duct and vascular structures. 38 It is also not prone to heat sink.…”

Section: Irreversible Electroporationmentioning

confidence: 99%

Interventional oncology: new techniques and new devices

Breuer

Ahmed

Al-Kouja

et al. 2022

The British Journal of Radiology

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Interventional oncology is a rapidly emerging field in the treatment of cancer. Minimally-invasive techniques such as trans-arterial embolization with chemotherapeutic and radioactive agents are established therapies and are found in multiple guidelines for the management of primary and metastatic liver lesions. Percutaneous ablation is also an alternative to surgery for small liver, renal, and pancreatic tumors. Recent research in the niche of interventional oncology has focused on improving outcomes of established techniques in addition to the development of novel therapies. In this review, we address recent and current advancements in devices, technologies, and techniques of chemoembolization and ablation: thermal ablation, histotripsy, high-intensity focused ultrasound, embolization strategies, liquid embolic agents, and local immunotherapy/antiviral therapies.

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“…However, high temperatures not only destroy tumor tissue but also increase morbidity if applied too close to structures such as bile duct, portal vein, superior mesenteric vein, celiac artery, or superior mesenteric artery, which all run in close proximity to the pancreas [3][4][5]. On the other hand, irreversible electroporation (IRE) leads to cell death by using high-voltage electrical pulses without destroying vascular collagen [6]. IRE, in contrast to thermal ablative techniques, always requires at least two needles, and metallic implants and cardiac arrhythmias are contraindications for this technique [6].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, irreversible electroporation (IRE) leads to cell death by using high-voltage electrical pulses without destroying vascular collagen [6]. IRE, in contrast to thermal ablative techniques, always requires at least two needles, and metallic implants and cardiac arrhythmias are contraindications for this technique [6]. Possible morbidity arises either from needle tract injuries (bleeding, local infection due to intestinal puncture) or from energy application-associated thrombosis or necrotic tissue leading again to infection.…”

Section: Introductionmentioning

confidence: 99%

Computer Assistance in the Minimally Invasive Ablation Treatment of Pancreatic Cancer

Eigl¹,

Ανδρέου²,

Peterhans³

et al. 2021

Challenges in Pancreatic Cancer

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The insertion of ablation needles towards pancreatic tumors demands excellent anatomical knowledge and interdisciplinary skills from the medical professional. While the placement of a single needle next to the structures at risk surrounding the pancreas is considered a challenging task, irreversible electroporation requires multiple needles to be placed in parallel at a specific location. Minimally invasive procedures complicate the already ambitious procedure, yet the ablation method bears potential to increase the overall survival for patients with locally advanced pancreatic cancer. Current studies require more clinical evidence regarding the efficacy of irreversible electroporation in pancreatic cancer by means of randomized controlled, multicenter trials. However, the ablation treatment is currently applied in expert centers only, which is due to the complex task of the needle placement. Computer-assisted surgery has shown its potential in different fields of applications to improve the targeting of diseased tissue and the confidence of the medical professional. The application of computer-assisted needle navigation for pancreatic cancer ablation holds the prospect to make the procedure more reproducible and safer.

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Irreversible Electroporation in Pancreatic Cancer

Cited by 3 publications

References 59 publications

The Impact of Patient Age ≥80 Years on Postoperative Outcomes and Treatment Costs Following Pancreatic Surgery

The Impact of Patient Age ≥80 Years on Postoperative Outcomes and Treatment Costs Following Pancreatic Surgery

Interventional oncology: new techniques and new devices

Computer Assistance in the Minimally Invasive Ablation Treatment of Pancreatic Cancer

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