Irreversible electroporation for the ablation of liver tumors: are we there yet?

OBJECTIVE: To explore irreversible electroporation (IRE) as a novel, nonthermal form of tissue ablation using high-voltage electrical current to induce pores in the lipid bilayer of cells, resulting in cell death. DATA SOURCES: PubMed searches were performed using the keywords electroporation, IRE, and ablation. The abstracts for the 2012 meetings of both the American Hepato-Pancreato-Biliary Association and the Society for Interventional Radiology were also searched. All articles and abstracts with any reference to electroporation were identified and reviewed. STUDY SELECTION: All studies and abstracts pertaining to electroporation. DATA EXTRACTION: All data pertaining to the safety and efficacy of IRE were extracted from preclinical and clinical studies. Preclinical data detailing the theory and design of IRE systems were also extracted. DATA SYNTHESIS: Preclinical studies have suggested that IRE may have advantages over conventional forms of thermal tumor ablation including no heat sink effect and preservation of the acellular elements of tissue, resulting in less unwanted collateral damage. The early clinical experience with IRE demonstrates safety for the ablation of human liver tumors. Short-term data regarding oncologic outcome is now emerging and appears encouraging.
CONCLUSION: Irreversible electroporation is likely to fill a niche void for the ablation of small liver tumors abutting a major vascular structure and for ablation of tumors abutting a major portal pedicle where heat sink and collateral damage must be avoided for maximum efficacy and safety. Studies are still needed to define the short-term and long-term oncologic efficacy of IRE.