[Irreversible electroporation in locally advanced pancreatic cancer].

Autor:	Polyakov AN; Blokhin National Medical Cancer Research Center, Moscow, Russia., Patyutko YI; Blokhin National Medical Cancer Research Center, Moscow, Russia., Kudashkin NE; Blokhin National Medical Cancer Research Center, Moscow, Russia., Kantieva DM; Blokhin National Medical Cancer Research Center, Moscow, Russia., Romanova KA; Blokhin National Medical Cancer Research Center, Moscow, Russia., Nasonova EA; Blokhin National Medical Cancer Research Center, Moscow, Russia., Korshak AV; Blokhin National Medical Cancer Research Center, Moscow, Russia., Egenov OA; Blokhin National Medical Cancer Research Center, Moscow, Russia., Podluzhnyi DV; Blokhin National Medical Cancer Research Center, Moscow, Russia.
Jazyk:	English; Russian
Zdroj:	Khirurgiia [Khirurgiia (Mosk)] 2023 (10), pp. 29-38.
DOI:	10.17116/hirurgia202310129
Abstrakt:	Objective: To determine the feasibility of irreversible electroporation (IRE) for locally advanced pancreatic adenocarcinoma. Material and Methods: Twenty-three patients underwent IRE after chemotherapy for locally advanced pancreatic cancer between 2015 and 2022. IRE was performed during laparotomy as a rule ( n =22). In one case, IRE was combined with palliative pancretoduodenectomy. Nineteen (86.3%) patients received adjuvant chemotherapy after the procedure. The follow-up examination included contrast-enhanced CT/MRI of the abdomen, chest X-ray or CT, analysis of CA 19-9 marker one month after surgery and then every three months. Results: Complications after IRE developed in 5 (21.7%) patients. Three patients (13.0%) had arrhythmia, two (8.7%) ones had pancreatic necrosis. A 90-day mortality after the procedure was 4.3% ( n =1), the cause was pancreatic necrosis. According to intraoperative data and the first examination (CT/MRI), the entire tumor infiltrate was treated in 21 (91.3%) cases. Median follow-up was 19 months. Median period until local recurrence was 15 months. Isolated local recurrence was observed in 7 patients. Of these, 3 ones underwent radiotherapy, one patient underwent repeated IRE. Distant metastases were found in 11 patients; systemic therapy was restarted. Median time to progression was 7 months after IRE and 14 months after initiation of chemotherapy. The median overall survival was 16 months after electroporation and 25 months after chemotherapy. Conclusion: Irreversible electroporation may be useful in carefully selected patients with unresectable locally advanced pancreatic adenocarcinoma after successful induction chemotherapy. This procedure provides local control, but the impact on long-term outcomes and feasibility of routine use should be analyzed in randomized trials.
Databáze:	MEDLINE
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