David Kwon1, Kelli McFarland1, Vic Velanovich2, Robert C G Martin3. 1. Department of Surgery, Henry Ford Hospital, Detroit, MI. 2. Department of Surgery, The University of South Florida, Tampa, FL. 3. Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY. Electronic address: Robert.martin@louisville.edu.
Abstract
INTRODUCTION: Complete tumor extirpation (R0 resection) remains the best possibility for long-term survival in patients with pancreatic adenocarcinoma. Unfortunately, approximately 80% of patients are not amenable to resection at diagnosis either because of metastatic (40%) or locally advanced disease (40%). Recent reports of irreversible electroporation (IRE), a high-voltage, short-pulse, cellular energy ablation device, have shown the modality to be safe and potentially beneficial to prognosis. IRE to augment/accentuate the margin during pancreatic resection for certain locally advanced pancreatic cancers has not been reported. METHODS: Patients with locally advanced/borderline resectable pancreatic cancer who underwent pancreatectomy with margin accentuation with IRE were followed in a prospective, institutional review board-approved database from July 2010 to January 2013. Data regarding local recurrence, margin status, and survival were evaluated. RESULTS: A total of 48 patients with locally advanced pancreatic/borderline cancers underwent pancreatectomy, including pancreatoduodenectomy (58%), subtotal pancreatectomy (35%), distal pancreatectomy (4%), and total pancreatectomy (4%), with IRE margin accentuation of the superior mesenteric artery and/or the anterior margin of the aorta. Most patients had undergone induction therapy with 33 patients (69%) receiving chemoradiation therapy and 18 patients chemotherapy for a median of 6 months (range, 4-13) before resection. A majority (54%) required vascular resection. A total of 9 patients (19%), sustained 21 complications with a median grade of 2 (range, 1-3), with a median duration of stay of 7 days (range, 4-58). With median follow-up of 24 months, 3 (6%) have local recurrence, with a median survival of 22.4 months. CONCLUSION: Simultaneous intraoperative IRE and pancreatectomy can provide an adjunct to resection in patients with locally advanced disease. Long-term follow-up has demonstrated a small local recurrence rate that is lower than expected. Continued optimization in multimodality therapy and consideration of appropriate patients could translate into a larger subset that could be treated effectively.
INTRODUCTION: Complete tumor extirpation (R0 resection) remains the best possibility for long-term survival in patients with pancreatic adenocarcinoma. Unfortunately, approximately 80% of patients are not amenable to resection at diagnosis either because of metastatic (40%) or locally advanced disease (40%). Recent reports of irreversible electroporation (IRE), a high-voltage, short-pulse, cellular energy ablation device, have shown the modality to be safe and potentially beneficial to prognosis. IRE to augment/accentuate the margin during pancreatic resection for certain locally advanced pancreatic cancers has not been reported. METHODS:Patients with locally advanced/borderline resectable pancreatic cancer who underwent pancreatectomy with margin accentuation with IRE were followed in a prospective, institutional review board-approved database from July 2010 to January 2013. Data regarding local recurrence, margin status, and survival were evaluated. RESULTS: A total of 48 patients with locally advanced pancreatic/borderline cancers underwent pancreatectomy, including pancreatoduodenectomy (58%), subtotal pancreatectomy (35%), distal pancreatectomy (4%), and total pancreatectomy (4%), with IRE margin accentuation of the superior mesenteric artery and/or the anterior margin of the aorta. Most patients had undergone induction therapy with 33 patients (69%) receiving chemoradiation therapy and 18 patients chemotherapy for a median of 6 months (range, 4-13) before resection. A majority (54%) required vascular resection. A total of 9 patients (19%), sustained 21 complications with a median grade of 2 (range, 1-3), with a median duration of stay of 7 days (range, 4-58). With median follow-up of 24 months, 3 (6%) have local recurrence, with a median survival of 22.4 months. CONCLUSION: Simultaneous intraoperative IRE and pancreatectomy can provide an adjunct to resection in patients with locally advanced disease. Long-term follow-up has demonstrated a small local recurrence rate that is lower than expected. Continued optimization in multimodality therapy and consideration of appropriate patients could translate into a larger subset that could be treated effectively.
Authors: Jennifer W Harris; Jeremiah T Martin; Erin C Maynard; Patrick C McGrath; Ching-Wei D Tzeng Journal: HPB (Oxford) Date: 2015-07-30 Impact factor: 3.647