Radiofrequency ablation of the pancreas with and without intraluminal duodenal cooling in a porcine model

Fegrachi, Samira; Molenaar, I.; Klaessens, John; Besselink, Marc G.; Offerhaus, Johan; Hillegersberg, Richard van

doi:10.1016/j.jss.2013.04.068

Cited by 28 publications

(24 citation statements)

References 15 publications

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“…However, RF pancreatic ablation has been repeatedly warned to be associated with severe necrotizing pancreatitis with lifethreatening haemorrhagic complications, among other critical and dangerous complications 15,27 . Even though, recent experiences seem to have reduced these severe complications using some prophylactic measures to avoid severe acute pancreatitis (such as exocrine secretion inhibition or reducing the ablative area to the tumor) 24,28,29 or thermal damage of the duodenum (using a duodenal cooling) 30 , this technique should be considered with extreme caution because of these serious complications 8 .…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

Quesada¹,

Burdı́o²,

Iglesias³

et al. 2015

Pancreatology

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Methods: Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15 and 21 days (Groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis) and incidence of POPF were evaluated.Results: A significant increase in serum amylase levels (p<0.05) on the 3 rd postoperative day which return to baseline levels in the following weeks was noted in groups 0-3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1-3 compared to group 0 and control groups showed a significant increase of small islets (<1000 μm 2 ). Conclusions:The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

Quesada¹,

Burdı́o²,

Iglesias³

et al. 2015

Pancreatology

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“…One of the primary reasons leading to the lack of efficient therapeutic treatments of this deadly disease is the difficulty in creation of adequate preclinical animal models. These models are crucial for not only studying the underlying mechanisms of pancreatic tumour initiation, growth and dissemination, but also developing new strategies for early detection and effective interventions [ 14 , 23 ]. Because there are no large animal models with pancreatic cancer so far, the technical verification achieved on normal large animals cannot be translated to clinical application.…”

Section: Discussionmentioning

confidence: 99%

Multi-modality imaging-monitored creation of rat orthotopic pancreatic head cancer with obstructive jaundice

et al. 2017

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PurposeTo investigate the feasibility of using multi-modality imaging to monitor the creation of rat models with orthotopic pancreatic head cancer with obstructive jaundice.Results27 of 52 rats (51.92%) developed pancreatic head cancer. The tumor formation rate was significantly higher in the animal group receiving bioluminescent tumor, compared to the group receiving non-bioluminescent donor tumors [78.1% (25/32 rats) vs 10.0% (2/20 rats), P = 0.0001]. Both ultrasound imaging and MRI clearly characterized the orthotopic tumors. Laboratory biochemistry test for those rats with obstructive jaundice showed elevated levels of bilirubin, aspartate transaminase (AST), alkaline phosphatase (ALT) and gamma-glutamyl transpeptidase (λ-GGT), compared with those rats without jaundice (P < 0.05). Correlative pathology confirmed that all tumors were ductal adenocarcinomas, and located in pancreatic head regions.Materials and MethodsRat pancreatic adenocarcinoma cells (DSL-6A/C1) were first transfected with lentivirus/mCherry-luciferase genes, and then subcutaneously implanted into flanks of donor immunocompetent Lewis rats, to create pancreatic tumor tissues. The tumor tissues from donor rats with either bioluminescence signal or without the signal were then transplanted into the pancreatic heads of 52 recipient Lewis rats. Bioluminescence optical and ultrasound imaging, as well as magnetic resonance imaging (MRI), were performed to follow up the tumor formation and growth in these tumor-transplanted rats. Physical examination and biochemistry test were used to discern the rats with obstructive jaundice. The rats were euthanized for subsequent histologic correlation and confirmation.ConclusionsWe successfully created a new rat model with orthotopic pancreatic head cancer, which can be accurately monitored and visualized by different imaging modalities.

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“…Later, ex vivo studies demonstrated that an adjustment of both temperature and length of the dispensed energy would conduce to better outcomes with fewer complications [ 16 , 17 ]. Although several temperatures have been used, ranging from less than 30°C to 90°C according to the equipment used to perform RFA [ 18 , 19 ], it seems that the ideal parameters to consider are actually represented by 90°C for 5 minutes, with a distance of 10 and 15 mm between probe and duodenum and portomesenteric axis, respectively [ 20 ]. The electrode must be introduced inside the tumor under ultrasound or CT-guidance and the procedure can be monitored in real time by ultrasound with a safe distance of the RFA probe from duodenum or portomesenteric vessels of 5–10 mm ( Figure 1 ).…”

Section: Physical Bases and Principles Of Techniquesmentioning

confidence: 99%

“…The most common complications reported in literature are gastrointestinal hemorrhages and minor local bleedings, acute pancreatitis (mild or severe), pancreatic and biliary fistulas, duodenal injury (thermal or direct), and portal vein thrombosis. It is suggested to cool the duodenum during the procedure with a cold saline solution administered using the nasogastric tube, to preserve it from the possible thermal injury [ 20 ].…”

Section: Complicationsmentioning

confidence: 99%

Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review

Paiella

Salvia

Ramera

et al. 2016

Gastroenterology Research and Practice

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Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for the 40% of the new diagnoses. Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques seem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible Electroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the use of these techniques have already demonstrated encouraging results in terms of safety and feasibility. Unfortunately, few studies on their efficacy are currently available. Even though some reports on the overall survival are encouraging, randomized studies are still required to corroborate these findings. This study provides an up-to-date overview and a thematic summary of the current available evidence on the application of RFA and IRE on PDAC, together with a comparison of the two procedures.

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Radiofrequency ablation of the pancreas with and without intraluminal duodenal cooling in a porcine model

Cited by 28 publications

References 15 publications

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

Multi-modality imaging-monitored creation of rat orthotopic pancreatic head cancer with obstructive jaundice

Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review

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