Endoscopic ultrasound-guided perivascular pancreatic radiofrequency ablation using a hydroxyethyl starch solution prior to pancreatectomy

Abstract

Background and study aim. Pancreatic surgery remains complex, particularly for borderline resectable and locally advanced tumours. Vascular invasion compromises resectability, and vascular resection entails increased morbidity and mortality. Following a feasibility and safety demonstration of an augmented endoscopic ultrasound (EUS) guided radiofrequency ablation (RFA) using hydroxyethyl starch (HES) in porcine pancreatic parenchyma, the present study assesses whether this approach (EUS-sugar-RFA) in the pancreatic perivascular space is safe and creates a controllable margin of necrosis to enable a vessel-sparing resection. Methods. EUS-sugar-RFA in the pancreatic parenchyma adjacent to the splenic artery and vein was performed in a live animal model. Following different survival periods (0-4 days) in the interventional group (n=3), open pancreatectomy was carried out. The control group (n=4) included open pancreatectomies in two pigs with non-treated pancreases and in two with pancreatic RFA alone on the same day. Results. All procedures were completed successfully, without intra- or postoperative complications. Survival periods were uncomplicated. Histopathological examination showed local necrosis and inflammatory reaction at the ablation sites. Vascular wall integrity was preserved in all specimens. The untreated pancreatic zones in the interventional group were no different from the normal pancreases in the control group. Conclusions. Preoperative perivascular augmented RFA using HES was safe, and in the pancreatic animal model the best timeframe was within 24h prior to pancreatic surgery. This technique might improve resectability in selected borderline and locally advanced pancreatic cancers.