Abstract
Background: Irreversible electroporation (IRE) is a novel ablation technique for treatment of unresectable cancer. Both in experimental and clinical studies, a waiting time between ablation and tissue analysis to allow for cell death through apoptosis, is often reported. However, the dynamics of IRE effect remain unknown. Therefore, this study aims to summarize these effects in relation to time between treatment and histological evaluation. Methods: A systematic search was performed in Pubmed, Embase and the Cochrane Library for studies using IRE on pancreas, liver or surrounding structures in animal or human studies. Data on pathology and time between IRE and histological evaluation were extracted. Results: Thirty-six articles were included, regarding IRE in liver, pancreas, blood vessels and nerves. In liver and pancreas, the first signs of apoptosis and haemorrhage were observed 1–2 hours after treatment, and remained visible until 24 hours in liver and 7 days in pancreas after which the damaged tissue was replaced by fibrosis. In blood vessels, the tunica media, intima and lumen remained unchanged for 24 hours. After 7 days, inflammation, fibrosis and loss of smooth muscle cells were seen, which persisted 35 days. In nerves, the time until histological changes was 24 hours. Conclusion: Tissue damage after IRE is a dynamic process with remarkable differences between tissue types. Whereas pancreas and liver showed the first damages after 1–2 hours, this may take 24 hours in nerves and even 7 days in blood vessels.
Highlights
Tumor necrosis as well as tumor-associated macrophages (TAMs) in tumor invasive front (TIF) have been suggested to have a prognostic value in solid tumors, inclusive hilar cholangiocarcinoma
Little is known regarding their influence on tumor progression and prognosis in intrahepatic cholangiocarcinoma
Patients with tumors characterized by necrosis or low CD68 density showed a significantly decreased recurrence-free and overall survival
Summary
Irreversible electroporation (IRE) is a novel ablation technique for treatment of unresectable cancer. Both in experimental and clinical studies, a waiting time between ablation and tissue analysis to allow for cell death through apoptosis, is often reported. Results: Thirty-six articles were included, regarding IRE in liver, pancreas, blood vessels and nerves. The first signs of apoptosis and haemorrhage were observed 1–2 hours after treatment, and remained visible until 24 hours in liver and 7 days in pancreas after which the damaged tissue was replaced by fibrosis. Whereas pancreas and liver showed the first damages after 1–2 hours, this may take 24 hours in nerves and even 7 days in blood vessels
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