Current role of the irreversible electrioporation in the treatment of advanced pancreatic carcinoma

Background: The prognosis of pancreatic adenocarcinoma is extremely poor. The incidence is rising worldwide including Czech Republic. Due to late diagnosis only 20% of patients are potentially operable. There is not any effective oncological treatment. Irreversible electroporation (IRE, Nano knife) have been used in cases of advanced disease since 2009. This method is safe but the long term outcomes are unknown.

Material and Methods: We have used IRE in the treatment of 50 patients with advanced inoperable pancreatic cancer since 2012. Half of them had had chemotherapy before IRE. The application of IRE was performed during laparotomy or under CT guidance. All patients have been treated by adjuvant chemotherapy (gemcitabine). Overall survival, early and late complications and quality of life were observed.

Results: The hospital stay was 11 days in cases of laparotomy application and 6 days after CT guided IRE. The complication occurred in 9 patients. Two of them were reoperated due to complication (biliary peritonitis in one case and sepsis in the other). Two patients died in postoperative course. We have repeatedly observed vanishing of PET CT activity after IRE but this effect was only temporally. Bile duct obstruction or biliary stent obstruction was the most often reason for readmissions. We did not recognize the prolongation of the survival time after procedure. Preliminary results show that quality of life is better after IRE then with chemotherapy only

Conclusions: IRE is safe and simple method for pancreatic tumor destruction. We have not observed downsizing of the tumor what is described in the literature. The quality of life seems be better after IRE. The proper role of IRE in the treatment of pancreatic tumors needs further studies.

Supported by grant No. NT 13263 Ministry of Health, Czech Republic

No conflict of interest.