The role of microwave ablation in management of functioning pancreatic neuroendocrine tumors

Abstract

Background: Surgical resection is considered to be the only potentially curative option for patients with pancreatic neuroendocrine tumors (pNETs). High risk rates of perioperative complications make minimally invasive ablative techniques a novel perspective and alternative treatment option for pancreatic neuroendocrine tumors. This study aims to present the first experience of using a microwave ablation in management of pNETs.Methods: Sechenov University has an experience of treating more than 400 patients with hormoneproducing tumors of the pancreas, 7 of which were treated by microwave ablation (MWA).Results: In all patients that underwent MWA, a regression of hormonal symptomatic was achieved. Two patients required readmission a month later for draining of pseudocyst and abscess. Conclusions:The exact role of microwave ablation in the treatment of non-metastatic pancreatic neuroendocrine tumors has not been defined yet. There is a lack of large prospective randomized studies and the reason for this is that local tumor destruction is indicated in selected cases only, thus making it difficult to analyze a large group of patients and assess long-term results of the treatment. However, microwave ablation allows to take a better control of symptoms in patients with hormone overproduction and in those with high risk of postoperative complications.

Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

“… 68 – 70 The pancreas is a thermo-sensitive organ, and ablation of normal pancreas tissue can lead to an inflammatory reaction causing oedema, cystic transformation and later fibrosis. 66 , 71 The first human pilot feasibility and safety study of EUS–guided RFA of the pancreatic lesion was published in 2015 using the Habib™ EUSRFA probe. 68 , 69 This was a prospective multi-centre study in which eight patients were enrolled: six with pancreatic cystic neoplasms (four mucinous cystic neoplasms, one intraductal papillary mucinous neoplasm, and one micro-cystic adenoma) and two with pNETs.…”

Pancreatic neuroendocrine tumours: spectrum of imaging findings

“…Zhang et al reported two rare cases of paragangliomas of the pancreas, which are typically hypervascular, with cystic changes mimicking pNETs (64). Furthermore, especially non-functioning pNETs that are bigger in size, may invade surrounding structures and present with biliary obstruction, as the classic presentation for pancreatic adenocarcinomas (65)(66)(67)(68).…”

Novel EUS-guided microwave ablation of an unresectable pancreatic neuroendocrine tumor

“…In addition, MWA lacks reliance on tissue impedance, is not limited by water vaporization and charring, 7 does not need an electrical circuit, and has a lower cost than RFA. 8 …”