The role of irreversible electroporation (IRE) for locally advanced pancreatic cancer: a systematic review of safety and efficacy

Abstract

Objectives: Irreversible electroporation (IRE) is a new modality for tumor ablation. Electrodes are placed around the tumor, and a pulsed, direct current with a field strength of 2000 V/cm is delivered. The direct current drives cells into apoptosis and cell death without causing significant heating of the tissues, which spares the extracellular matrix and proteins. The purpose of this review was to evaluate current experience of IRE for the ablation of pancreatic cancer.Material and methods: We searched PubMed for all studies of IRE in human pancreatic cancer in English reporting at least 10 patients.Results: The search yielded 10 studies, comprising a total of 446 patients. Percutaneous IRE was done in 142 patients, while 304 patients were treated during laparotomy. Tumor sizes ranged from median 2.8 to 4.5 cm. Post-procedural complications occurred in 35% of patients, most of them were less severe. Nine patients (2.0%) died after the procedure. The technical success rate was 85–100%. The median recurrence-free survival was 2.7–12.4 months after IRE treatment. The median overall survival was 7–23 months postoperatively. The longest overall survival was noted when IRE was used in conjunction with pancreatic resection.Conclusions: IRE seems feasible and safe with a low post-procedural mortality. Further efforts are needed to address patient selection and efficacy of IRE, as well as the use of IRE for ‘margin accentuation’ during surgical resection.