Evaluation of thermal injury to liver, pancreas and kidney during irreversible electroporation in an <i>in vivo</i> experimental model

Dunki-Jacobs, Erik M.; Philips, Prejesh; Martin, Robert C.G.

doi:10.1002/bjs.9536

Cited by 102 publications

(87 citation statements)

References 29 publications

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“…Other studies have concluded that IRE does not produce significant thermal energy, at least when using settings most commonly applied in clinical treatment, but it has been shown that the presence of a metallic stent could increase the risk of producing thermal injuries, due to metal conductivity[56,68]. This aspect is therefore fundamental to keep in mind when treating patients who are carrying a biliary metallic stent for jaundice palliation.…”

Section: Techniques and Resultsmentioning

confidence: 99%

Percutaneous ablation of pancreatic cancer

D’Onofrio

Ciaravino

Robertis

et al. 2016

WJG

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Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

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Section: Techniques and Resultsmentioning

confidence: 99%

Percutaneous ablation of pancreatic cancer

D’Onofrio

Ciaravino

Robertis

et al. 2016

WJG

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show abstract

“…However, to perform either the percutaneous approach or the open technique we need dedicated experienced interventional radiologists and these approaches might be done in a high-volume center of pancreatic surgery. The percutaneous approach, as well as the open one, is inapplicable in case of metallic biliary or duodenal stents (at least without removing them before performing IRE), because the presence of the metal that could transfer thermal energy causing injuries [35]. This aspect, together with suffering from cardiac arrhythmias (or in patients with pacemakers), represents an absolute contraindication to IRE.…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Irreversible Electroporation (IRE) in Patients with Locally Advanced Pancreatic Cancer: Results of a Prospective Study

et al. 2015

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Purpose: To evaluate the safety of the NanoKnife Low Energy Direct Current (LEDC) System (Irreversible Electroporation, IRE) in order to treat patients with unresectable pancreatic adenocarcinoma. Methods: Prospective, nonrandomized, single-center clinical evaluation of ten patients with a cytohystological diagnosis of unresectable locally advanced pancreatic cancer (LAPC) that was no further responsive to standard treatments. The primary outcome was the rate of procedure-related abdominal complications. The secondary endpoints included the evaluation of the short-term efficacy of IRE through the evaluation of tumor reduction at imaging and biological tumor response as shown by CA 19-9, clinical assessments and patient quality of life. Results: Ten patients (5 males, 5 females) were enrolled, with a median age of 66 and median tumor size of 30 mm. All patients were treated successfully with a median procedure time of 79.5 min. Two procedure-related complications were described in one patient (10%): a pancreatic abscess with a pancreoduodenal fistula. Three patients had early progression of disease: one patient developed pulmonary metastases 30 days post-IRE and two patients had liver metastases 60 days after the procedure. We registered an overall survival of 7.5 months (range: 2.9-15.9). Conclusions: IRE is a safe procedure in patients with LAPC and may represent a new technological option in the treatment and multimodality management of this disease.

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“…Biological tissues are by nature resistors and the Joule heating cannot therefore be zero. The rise in temperature caused by electroporation in an experimental study was up to 60 • C [6]. This level of hyperthermia however only occurs in the immediate proximity to the electrodes (fine, 19 G straight and not cooled) and only for a few tens of s. Ultimately the ''actual'' thermal effect of electroporation is very limited and only affects tissues located in a radius of a few millimeters around the electrodes.…”

Section: Electroporation: When Thermo-ablation Is Too Riskymentioning

confidence: 96%

Ablative therapies: Advantages and disadvantages of radiofrequency, cryotherapy, microwave and electroporation methods, or how to choose the right method for an individual patient?

Séror

2015

Diagnostic and Interventional Imaging

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Several ablation techniques are currently available. Except for electroporation, all of these methods cause fatal damage at a cellular level and irreversible architectural deconstruction at a tissue level by thermal effects. Ablation of a tumor using one of these techniques, whether thermal or otherwise, requires applicators to be positioned from which the energy is delivered in situ. Some techniques, however, require several applicators to be inserted (multibipolar radiofrequency, cryotherapy and electroporation) whereas a single applicator is often sufficient with other technologies (monopolar radiofrequency and microwave). These methods are conceptually very similar but are distinguished from each other in practice through the technologies they use. It is essential to understand these differences as they influence the advantages and limitations of each of the techniques. There is no such thing as the perfect multifunctional ablation device and choice is dictated on an individual patient basis depending on the aim of treatment, which itself depends on each patient's clinical situation.

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Evaluation of thermal injury to liver, pancreas and kidney during irreversible electroporation in an in vivo experimental model

Cited by 102 publications

References 29 publications

Percutaneous ablation of pancreatic cancer

Percutaneous ablation of pancreatic cancer

Safety and Feasibility of Irreversible Electroporation (IRE) in Patients with Locally Advanced Pancreatic Cancer: Results of a Prospective Study

Ablative therapies: Advantages and disadvantages of radiofrequency, cryotherapy, microwave and electroporation methods, or how to choose the right method for an individual patient?

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