Irreversible Electroporation of Malignant Lesions: An Institution Experience

Background: Irreversible electroporation (IRE) is a tumor ablation technique where short, high-voltage pulses are applied to tumors to permeabilize the cell membranes. Since no thermal energy is created, it can be used near vital structures. We report our experience in a wide array of anatomic locations and on diverse oncologic processes.

Methods: We performed a retrospective review of all IRE cases performed at our institution from September 2010 to September 2013. Patients were evaluated for peri-operative morbidity, mortality, and oncologic outcome.

Results: Twenty-seven patients underwent IRE during 16 laparotomies and 12 CT guided percutaneous procedures. Anatomic locations: 9 liver, 7 pancreas, 7 pelvis, 2 retroperitoneal, 1 lung, 1 chest wall, and 1 mesentery. Lesion types: 14 metastases, 8 primary tumors, 5 recurrences, and 1 lesion not confirmed malignant. Three cases involved margin accentuation prior to resection. One treated the IVC margin of a radiofrequency ablation site. Twenty-four procedures attempted complete ablation. Lesions ranged from 1.0 cm to 6.0 cm. Median hospital stay: 1 day (percutaneous treatment) and 9 days (laparotomy). 30-day mortality was 0%. Complications included muscle weakness, gastric outlet obstruction, intragastric hematoma, pancreatic fistula, small bowel obstruction, and urinary retention. Another patient experienced obstructive jaundice and portal vein thrombosis. Eight patients developed recurrence. The median length of follow-up is 12.5 months.

Conclusion: Our experience suggests that IRE is safe and feasible in a variety of situations. Several pitfalls were identified to prevent unnecessary morbidity. Our data suggests a local control benefit, but randomized studies are needed.