Percutaneous and Intraoperative Irreversible Electroporation of Liver Cancer – A Monocenter Experience

Abstract

Background: There is a huge variety of image guided local ablation technique to treat primary and secondary liver cancer. While thermal ablations are most common, these modalities have some limitations like coagulation necrosis to adjacent structures or undesired heat sink near to larger vessels. This indicates the need of alternative techniques to enable ablation of tumors not suitable for thermal procedures. Method: Irreversible electroporation (IRE) is a relatively young image guided ablation method based on ultra-short electricity pulses inducing apoptotic cell death. IRE in the liver is suggested to preserve critical vascular and biliary structures from procedure related coagulation necrosis and is therefore expected to overcome limitations of thermal ablation techniques. We retrospectively assessed our patients treated with IRE regarding procedure safety, short-term complications and local tumor recurrence. Results: We treated 12 patients either with percutaneous CT guided IRE or with open surgical ultrasound guided IRE. The ablation was technically successful in all cases. There were three short-term complications (1 hematoma, 1 bilioma, 1 liver vein thrombosis) and one superficial track metastasis on follow up imaging. Discussion: IRE is a feasible ablation technique for primary and secondary liver cancer and can be the only remaining curative treatment option. However the previously stated preservation of critical vascular structures has to be regarded critically. The missing possibility for track ablation in IRE may indicate a potentially higher risk for inducing track metastases. However further clinical data are necessary to state the value of IRE in comparison to other ablation methods.