Treatment of unresectable pancreatic carcinoma by radiofrequency ablation with 'cool-tip needle': report of 18 cases

Abstract

To explore the effects of treatment of unresectable pancreatic tumors by radiofrequency ablation (RFA) with "cool-tip needle". 18 patients with unresectable pancreatic tumors, 8 with pancreatic head carcinoma and 10 with pancreatic body and tail carcinomas, 12 males and 6 females, aged 66.2, underwent RFA under laparotomy for 3 times and simultaneous infusion of iced normal saline. The clinical data were retrospectively analyzed. The level of CA19-9, a tumor marker, returned to normal after RF in 2 patients. Back pain was alleviated in 14 patients. B mode ultrasonography or CT examination showed decrease of tumor volume in 14 patients after RF. Pancreatic fistula occurred in 3 patients (16.7%) and then healed smoothly in 7 - 10 days with after routine abdominal drainage. The mortality was 22.2% (4/18). In the 4 death cases, tumors were all located in the pancreatic head; three patients died suddenly of massive gastrointestinal hemorrhage at Days 4, 30, and 40 days postoperative respectively after RF and the other patient died of acute renal failure at Day 2 postoperative days after RF. 8 patients died 1 - 8 months after RF. After 51 months, 1 patient still survived. RFA is effective in relieving the back pain for in unresectable pancreatic tumor patients efficiently relieving the back pain. Standard use of cool-tip RFA is dangerous for pancreatic head tumor carcinoma close to portal vein, but safe for those located in the body and tail of the pancreas. Making the Infusion of iced cooling-water flow via a gastric tube into the duodenum and changing change of the parameters of the RF system can reduce the associated complications.