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Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of the present systematic review was to collect, analyze, and critically evaluate the role of irreversible electroporation (IRE) in locally advanced pancreatic cancer (LAPC). Furthermore, we sought to analyze the different approaches of IRE (open, laparoscopic, and percutaneous) and assess the relative outcomes.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using the MEDLINE (1966–2018), Scopus (2004–2018), Google Scholar (2004–2018) and ClinicalTrials.gov databases, eligible articles published up to August 2018 were included. The following keywords were applied: ‘irreversible electroporation’, ‘IRE’, ‘LAPC’, ‘unresectable pancreatic cancer’, ‘palliative treatment’, ‘locally advanced pancreatic cancer’, ‘ablation’ and ‘ablative treatment’.

Results

IRE for LAPC was feasible and safe; however, it was associated with morbidity in approximately one in three patients, some of whom experienced serious complications, particularly after surgical IRE. In addition, while mortality following IRE was uncommon, it did occur in 2% of patients. While some studies suggested a survival benefit, others failed to note an improvement in long-term outcomes following IRE compared with other therapies.

Conclusions

Providers and patients need to be aware of the potential morbidity and mortality associated with IRE. In addition, based on the literature to date, the survival benefit of IRE for LAPC remains to be elucidated. Conclusive and definitive evidence to support a survival benefit of IRE does not currently exist. Future multicenter, randomized, prospective trials are needed to clarify the role of IRE in patients with LAPC.

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Authors and Affiliations

  1. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA

    Dimitrios Moris MD, MSc, PhD, Diamantis I. Tsilimigras MD, Aslam Ejaz MD & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  2. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Dimitrios Moris MD, MSc, PhD

  3. First Department of Surgery, Laikon General Hospital, University of Athens Medical School, Athens, Greece

    Nikolaos Machairas MD, PhD, Diamantis I. Tsilimigras MD, Anastasia Prodromidou MD, Natasha Hasemaki MD & Evangelos Felekouras MD, PhD

  4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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Moris, D., Machairas, N., Tsilimigras, D.I. et al. Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer. Ann Surg Oncol 26, 1657–1668 (2019). https://doi.org/10.1245/s10434-019-07261-7

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  • DOI: https://doi.org/10.1245/s10434-019-07261-7

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