Abstract
Simple SummaryThis literature review shows preliminary evidence to suggest that electroporation, the use of electricity to cause the death of cells around the tumour, may be associated with an improved survival and complete resection rates following pancreatic surgery for higher stage pancreatic cancer. However, one in five patients have a complication from the procedure that alters their normal course in hospital. Moreover, the number of patients who underwent this technique is small and further data is needed to support the preliminary evidence. The results therefore should be interpreted with caution.The present systematic review aimed to summarise the available evidence on indications and oncological outcomes after MA IRE for stage III pancreatic cancer (PC). A literature search was performed in the Pubmed, MEDLINE, EMBASE, SCOPUS databases using the PRISMA framework to identify all MA IRE studies. Nine studies with 235 locally advanced (LA) (82%, 192/235) or Borderline resectable (BR) PC (18%, 43/235) patients undergoing MA IRE pancreatic resection were included. Patients were mostly male (56%) with a weighted-mean age of 61 years (95% CI: 58–64). Pancreatoduodenectomy was performed in 51% (120/235) and distal pancreatectomy in 49% (115/235). R0 resection rate was 73% (77/105). Clavien Dindo grade 3–5 postoperative complications occurred in 19% (36/187). Follow-up intervals ranged from 3 to 29 months. Local and systematic recurrences were noted in 8 and 43 patients, respectively. The weighted-mean progression free survival was 11 months (95% CI: 7–15). The weighted-mean overall survival was 22 months (95% CI 20–23 months) and 8 months (95% CI 1–32 months) for MA IRE and IRE alone, respectively. Early non-randomised data suggest MA IRE during pancreatic surgery for stage III pancreatic cancer may result in increased R0 resection rates and improved OS with acceptable postoperative morbidity. Further, larger studies are warranted to corroborate this evidence.
Highlights
Licensee MDPI, Basel, Switzerland.Pancreatic cancer is one of the most aggressive malignancies and the seventh leading cause of cancer-related death worldwide [1]
Stage three pancreatic cancer is defined as a cancer that involves major vascular structures and is further subcategorised based on the extent of the vascular involvement into borderline resectable (BRPC) and locally advanced unresectable pancreatic cancer (LAPC) [4]
LAPC comprised the significant majority of the cohort (82%, 192/235), 43 BRPC (18%) patients were present in three studies [17,27,29] (Table 2)
Summary
Licensee MDPI, Basel, Switzerland.Pancreatic cancer is one of the most aggressive malignancies and the seventh leading cause of cancer-related death worldwide [1]. Surgical resection remains the only effective potential curative therapy but only 10–20% are amenable for resection at the time of diagnosis [2]. This is due to the fact that around 85% of patients present with locally advanced disease (stage three) or have metastases (stage four) [3]. Stage three pancreatic cancer is defined as a cancer that involves major vascular structures and is further subcategorised based on the extent of the vascular involvement into borderline resectable (BRPC) and locally advanced unresectable pancreatic cancer (LAPC) [4]. BRPC with venous involvement is often considered resectable, on the contrary
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