Ann Hepatobiliary Pancreat Surg.  2025 Feb;29(1):72-78. 10.14701/ahbps.24-193.

Irreversible electroporation as an intraoperative adjunctive treatment for locally advanced pancreatic cancer after neoadjuvant therapy: An initial clinical experience

• Patel A
• Lancellotti F
• Siriwardena AK
• Nadarajah V
• Carino NdL
• on behalf of HPB-MRI Collaborative Group

• KMID: 2565409
• DOI: http://doi.org/10.14701/ahbps.24-193

Abstract

Backgrounds/Aims
Irreversible electroporation (IRE) may have a potential application as either a “back-up therapy” or for margin accentuation during trial dissection of locally advanced pancreatic cancer (LAPC). The aim of this report was to describe our experience with IRE in terms of its potential applications mentioned above.
Methods
A clinical policy to use IRE in LAPC patients undergoing exploratory surgery after neoadjuvant therapy (NAT) was initiated in 2017. If resection was feasible, IRE was used for margin accentuation. If not, then IRE was undertaken as a “back-up therapy” of non-resectable tumor. Data on baseline characteristics, perioperative 90-day morbidity, recurrence-free survival (RFS) and overall survival (OS) were collected.
Results
IRE was successfully performed in 18 (95%) patients. IRE was abandoned in one case for technical reasons. Nine patients who were found to have an unresectable disease underwent IRE as a “back-up therapy” while the remaining patients received IRE for margin accentuation. Complications were recorded in 33% patients. There was no procedure-related mortality. In the group receiving IRE for margin accentuation, the median RFS was 10.0 months (range, 4.5–15.0 months). The median OS of our cohort was 22 months (range, 14.75–27.50 months).
Conclusions
This report shows that in patients with LAPC undergoing exploratory surgery following NAT, IRE seems technically feasible for margin accentuation or as a “back-up therapy”. More data are needed to determine procedure-related morbidity, mortality, and any effects of IRE on cancer-related survival.

Keyword

Locally advanced pancreatic cancer; Irreversible electroporation; Pulsed electric fields; Margin accentuation; Neoadjuvant chemotherapy

Reference

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