Patryk Kambakamba1, John M Bonvini2, Michael Glenck3, Liliana Castrezana López1, Thomas Pfammatter3, Pierre-Alain Clavien1, Michelle L DeOliveira4. 1. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. 2. Department of Anesthesiology, University Hospital Zurich, Switzerland. 3. Department of Radiology, Interventional Radiology Center, University Hospital Zurich, Switzerland. 4. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Electronic address: michelle.deoliveira@usz.ch.
Abstract
BACKGROUND: Irreversible electroporation is increasingly used for treatment of solid tumors, but safety data remain scarce. This study aimed to describe intraoperative adverse events associated with irreversible electroporation in patients undergoing solid tumor ablation. METHODS: We analyzed demographic and intraoperative data for patients (n = 43) undergoing irreversible electroporation for hepato-pancreato-biliary and retroperitoneal malignancies (2012 to 2015). Adverse events were defined as cardiac, surgical, or equipment-related. RESULTS: Adverse events (n = 20, 47%) were primarily cardiac (90%, n = 18), including blood pressure elevation (77%, n = 14/18) and arrhythmia (16%, n = 7/43). All but one was managed medically, 1 patient with arrhythmia required termination of ablation. Bleeding and technical problems with the equipment occurred in 1 patient each. Multivariable analysis revealed previous cardiovascular disease and needle placement close to the celiac trunk associated with increased likelihood for cardiac events. CONCLUSIONS: Intraoperative cardiac adverse events are common during irreversible electroporation but rarely impair completion of the procedure.
BACKGROUND: Irreversible electroporation is increasingly used for treatment of solid tumors, but safety data remain scarce. This study aimed to describe intraoperative adverse events associated with irreversible electroporation in patients undergoing solid tumor ablation. METHODS: We analyzed demographic and intraoperative data for patients (n = 43) undergoing irreversible electroporation for hepato-pancreato-biliary and retroperitoneal malignancies (2012 to 2015). Adverse events were defined as cardiac, surgical, or equipment-related. RESULTS: Adverse events (n = 20, 47%) were primarily cardiac (90%, n = 18), including blood pressure elevation (77%, n = 14/18) and arrhythmia (16%, n = 7/43). All but one was managed medically, 1 patient with arrhythmia required termination of ablation. Bleeding and technical problems with the equipment occurred in 1 patient each. Multivariable analysis revealed previous cardiovascular disease and needle placement close to the celiac trunk associated with increased likelihood for cardiac events. CONCLUSIONS: Intraoperative cardiac adverse events are common during irreversible electroporation but rarely impair completion of the procedure.
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802