Irreversible Electroporation of the Pancreas: Definitive Local Therapy Without Systemic Effects

Background: The use of thermal tumor ablative techniques in the pancreas is limited due to the risk of pancreatitis and damage to major vascular structures. Irreversible electroporation (IRE) is a non-thermal ablation technique that could allow ablation in the pancreas while preserving vital surrounding blood vessels. The aim of this study was to assess the safety and ablation volume of IRE in porcine pancreatic tissue.Methods: IRE of swine pancreases was performed using an open technique and ultrasound guidance and the animals were followed for 72 hr, 7 days, and 14 days post-IRE.Results: All pigs underwent IRE, with one pig was unsuccessful after three attempts using at 3,000 V due to inability to achieve a stable current. All animals recovered well and revealed only mild adhesions, no ascites, and no pancreatic necrosis. All animals had transient increases in amylase and lipase that normalized on post-IRE day 3. Pathologic analysis revealed that ablation defects (median size 3 cm x 2.8 cm) were seen in electroporated areas with significant destruction of the pancreatic tissue with patent vascular structures.Conclusions: This animal model demonstrates that IRE of the pancreas performed at an optimal voltage is well tolerated, with rapid resolution of pancreatic inflammation and preservation of vascular structures. J. Surg. Oncol. 2011;104:22-28. (C) 2011 Wiley-Liss, Inc.

背景：由于胰腺炎风险以及对主要血管结构的损伤，热肿瘤消融技术在胰腺中的应用受到限制。不可逆电穿孔（IRE）是一种非热消融技术，可在消融胰腺的同时保护周围重要血管。本研究旨在评估IRE在猪胰腺组织中的安全性和消融体积。 方法：采用开放技术及超声引导对猪胰腺进行IRE，并在IRE术后72小时、7天和14天对动物进行观察。 结果：所有猪均接受了IRE，其中1头猪在3000伏电压下尝试3次后因无法获得稳定电流而未成功。所有动物恢复良好，仅显示轻度粘连，无腹水，无胰腺坏死。所有动物的淀粉酶和脂肪酶均短暂升高，并在IRE术后第3天恢复正常。病理分析显示，在电穿孔区域可见消融缺损（中位大小为3厘米×2.8厘米），胰腺组织明显破坏，但血管结构通畅。 结论：该动物模型表明，在最佳电压下对胰腺进行IRE具有良好的耐受性，胰腺炎症可快速消退，血管结构得以保留。《外科肿瘤学杂志》2011年；104：22 - 28。（C）2011威利 - 利斯公司