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Irreversible Electroporation: an Institution Experience
Benjamin J. Bates*, Minia Hellan, Shannon Kauffman, James Ouellette
Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH
Background: Irreversible electroporation (IRE) is a tumor ablation technique in which short, high-voltage pulses are applied to tumors to permeabilize the cell membranes. Since no thermal energy is created, it can be used close to vital structures. We report our experience with this novel technique in a wide array of anatomic locations and on a diversity of oncologic processes.
Methods: We performed a retrospective data review of all IRE cases performed at our institution from September 2010 to September 2013. These patients were evaluated for peri-operative morbidity, mortality, and oncologic outcome. A total of 28 IRE procedures on 27 patients were evaluated.
Results: 27 Patients (11 women and 16 men) underwent IRE by either surgeon (16 open operations) or interventional radiologist (12 CT guided percutaneous procedures). The median age was 63 years (range 29 to 82 years) and median BMI of 30.7. IRE procedures were performed in the following anatomic locations: 9 liver, 7 pancreas, 7 pelvis, 2 retroperitoneal, 1 lung, 1 chest wall, and 1 mesentery. The lesion types consisted of 14 metastases, 8 primary tumors, 5 tumor recurrences, and 1 lesion not confirmed malignant. Three open procedures were performed for margin accentuation prior to resection (including a pelvic sarcoma, recurrent bladder cancer, and pancreatic cancer). One treated the IVC margin of a previous radiofrequency ablation treatment site in the liver. The remaining 24 procedures attempted complete ablation of the index lesion. Lesions ranged from 1.0 to 6.0 cm. Patients treated percutaneously had a median hospital stay of 1 day; the median hospital stay for the surgical (laparotomy) patients was 9 days. The overall 30-day mortality was 0% and IRE related complications occurred in 8 patients. Complications included two patients with muscle weakness, one gastric outlet obstruction, one intragastric hematoma, one pancreatic fistula, one small bowel obstruction, and one episode of urinary retention following pelvic IRE. Another patient experienced complications of obstructive jaundice, portal vein thrombosis, and an IRE site abscess. Six patients developed evidence of disease recurrence at the IRE site. The overall median length of follow-up is 8 months (range 1 to 30 months).
Conclusion: Our comprehensive early experience suggests that IRE is safe and feasible for a wide array of oncologic processes and in multiple anatomic locations. Several pitfalls have now been identified to prevent unnecessary morbidity. Our data suggests a local control benefit but we cannot report on possible survival benefit due to the limited number of patients and different malignancies treated. Overall this technology is a promising new tool; however further trials are needed to better understand the possible benefits.
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