Samira Fegrachi1, Marieke S Walma1, Jan J J de Vries2, Hjalmar C van Santvoort1, Marc G Besselink3, Erik G von Asmuth1, Maarten S van Leeuwen4, Inne H Borel Rinkes1, Rutger C Bruijnen4, Ignace H de Hingh5, Joost M Klaase6, I Quintus Molenaar1, Richard van Hillegersberg7. 1. Departments of Surgery, University Medical Center Utrecht Cancer Center, St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. 2. Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. 3. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands. 4. Department of Radiology, University Medical Center Utrecht Cancer Center, University of Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. 5. Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands. 6. Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. 7. Departments of Surgery, University Medical Center Utrecht Cancer Center, St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. Electronic address: r.vanhillegersberg@umcutrecht.nl.
Abstract
INTRODUCTION: Radiofrequency ablation (RFA) has been proposed as a new treatment option for locally advanced, unresectable pancreatic cancer (LAPC). In preparation of a randomized controlled trial (RCT), the aim of this phase II study was to assess the safety of RFA for patients with LAPC. MATERIALS AND METHODS: Patients diagnosed with LAPC confirmed during surgical exploration between November 2012 and April 2014 were eligible for inclusion. RFA probes were placed under ultrasound guidance with a safety margin of at least 10 mm from the duodenum and 15 mm from the portomesenteric vessels. During RFA, the duodenum was continuously perfused with cold saline to reduce risk for thermal damage. Primary outcome was defined as the amount of major complications (Clavien-Dindo grade ≥III). RFA-related complications were predefined as: pancreatic fistula, pancreatitis, thermal damage to the portomesenteric vessels and duodenal perforation. RESULTS: In total, 17 patients underwent RFA. Delayed gastric emptying (DGE) requiring endoscopic feeding tube placement occurred in 4 patients (24%) as only major complication. Five patients (29%) had a major complication other than DGE. One (6%) RFA-related major complications occurred. One patient (6%) died due to complications from a biliary leak following hepaticojejunostomy. After evaluation of the first 5 patients, gastrojejunostomy was no longer performed routinely. Since then severe DGE seemed to occur less (3/5 vs. 3/12 grade C DGE). CONCLUSION: RFA is a major, but safe procedure for patients with LAPC if performed with strict predefined safety criteria. A RCT is currently investigating the true effectiveness of RFA in patients with LAPC.
INTRODUCTION: Radiofrequency ablation (RFA) has been proposed as a new treatment option for locally advanced, unresectable pancreatic cancer (LAPC). In preparation of a randomized controlled trial (RCT), the aim of this phase II study was to assess the safety of RFA for patients with LAPC. MATERIALS AND METHODS:Patients diagnosed with LAPC confirmed during surgical exploration between November 2012 and April 2014 were eligible for inclusion. RFA probes were placed under ultrasound guidance with a safety margin of at least 10 mm from the duodenum and 15 mm from the portomesenteric vessels. During RFA, the duodenum was continuously perfused with cold saline to reduce risk for thermal damage. Primary outcome was defined as the amount of major complications (Clavien-Dindo grade ≥III). RFA-related complications were predefined as: pancreatic fistula, pancreatitis, thermal damage to the portomesenteric vessels and duodenal perforation. RESULTS: In total, 17 patients underwent RFA. Delayed gastric emptying (DGE) requiring endoscopic feeding tube placement occurred in 4 patients (24%) as only major complication. Five patients (29%) had a major complication other than DGE. One (6%) RFA-related major complications occurred. One patient (6%) died due to complications from a biliary leak following hepaticojejunostomy. After evaluation of the first 5 patients, gastrojejunostomy was no longer performed routinely. Since then severe DGE seemed to occur less (3/5 vs. 3/12 grade C DGE). CONCLUSION: RFA is a major, but safe procedure for patients with LAPC if performed with strict predefined safety criteria. A RCT is currently investigating the true effectiveness of RFA in patients with LAPC.
Authors: Muhammad Nadeem Yousaf; Hamid Ehsan; Ahmad Muneeb; Ahsan Wahab; Muhammad K Sana; Karun Neupane; Fizah S Chaudhary Journal: Front Med (Lausanne) Date: 2021-02-11
Authors: Florentine E F Timmer; Bart Geboers; Sanne Nieuwenhuizen; Evelien A C Schouten; Madelon Dijkstra; Jan J J de Vries; M Petrousjka van den Tol; Tanja D de Gruijl; Hester J Scheffer; Martijn R Meijerink Journal: Curr Oncol Rep Date: 2021-04-17 Impact factor: 5.075
Authors: M S Walma; S J Rombouts; L J H Brada; H C van Santvoort; M G Besselink; I Q Molenaar; I H Borel Rinkes; K Bosscha; R C Bruijnen; O R Busch; G J Creemers; F Daams; R M van Dam; O M van Delden; S Festen; P Ghorbani; D J de Groot; J W B de Groot; N Haj Mohammad; R van Hillegersberg; I H de Hingh; M D'Hondt; E D Kerver; M S van Leeuwen; M S Liem; K P van Lienden; M Los; V E de Meijer; M R Meijerink; L J Mekenkamp; C Y Nio; I Oulad Abdennabi; E Pando; G A Patijn; M B Polée; J F Pruijt; G Roeyen; J A Ropela; M W J Stommel; J de Vos-Geelen; J J de Vries; E M van der Waal; F J Wessels; J W Wilmink Journal: Trials Date: 2021-04-29 Impact factor: 2.279