Margin ACcentuation for resectable Pancreatic cancer using Irreversible Electroporation - Results from the MACPIE-I...

Area of Science:

• Oncology
• Surgical Oncology
• Medical Devices

Background:

• Resectable pancreatic cancer (RPC) often requires wide surgical margins to achieve negative R1 resection.
• Achieving negative margins can be challenging, particularly at the posterior and superior mesenteric vein (SMV) pancreatic neck.
• Margin accentuation (MA) techniques aim to improve margin status during pancreaticoduodenectomy (PD).

Purpose of the Study:

• To evaluate the efficacy of margin accentuation using Irreversible electroporation (IRE) in reducing positive surgical margins during pancreaticoduodenectomy for resectable pancreatic head tumors.
• To assess the safety and feasibility of IRE-assisted MA in RPC surgery.

Main Methods:

• A pilot study involving 20 patients undergoing MA with IRE prior to PD for RPC.
• IRE was applied to the posterior and SMV margins, and pancreatic neck.
• A control group (n=91) underwent standard PD without IRE MA.
• Comparison of margin positivity rates, complications, disease-free survival (DFS), and overall survival (OS) between groups.

Main Results:

• The IRE group showed a lower overall margin positive rate (35.0%) compared to the non-IRE group (51.6%).
• Significantly lower positivity was observed at the posterior pancreatic margin (5.0% vs. 25.3%) and treated margins excluding SMA (20.0% vs. 51.6%) in the IRE group.
• No significant differences in intra- or post-operative complications, DFS, or OS were noted between the groups.
• Median follow-up was 15.6 months.

Conclusions:

• Margin accentuation using IRE is a safe and promising technique for reducing positive surgical margins in resectable pancreatic cancer.
• The findings suggest IRE MA can improve R1 resection rates, a critical factor in pancreatic cancer surgery.
• Further validation through a randomized controlled trial is recommended to confirm these preliminary results.