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Published on: June 8, 2018
A retrospective study of irreversible electroporation for tumors adjacent to perihepatic important structure
Ju Gong1, Shunhong Wang1, Shuting Wang1,2
1Department of Interventional Radiology, Ruijin Hospital Luwan Branch, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Background:
Irreversible electroporation has been proved as a feasible and safe method against tumor in liver. However, few studies focused on tumors adjacent to perihepatic important structure like vessels, biliary system and gall bladder. These structures limit the effectiveness of conventional treatments. The aim of this article is to analyze the clinical outcomes of patients with hepatic tumors at the special sites who received IRE treatment and provide reliable evidence for broadening the scope of IRE's clinical application.
Methods:
The clinical information of patients who underwent IRE ablation for tumors adjacent to perihepatic important structure between February 2017 and December 2021 was collected and retrospectively analyzed. All patients underwent contrast-enhanced CT or MRI for further evaluation at the 1-month follow-up and every 3 months thereafter. Post-ablation complications, recurrence, progression-free survival and overall survival were evaluated to analyze the prognosis of IRE ablation adjacent to perihepatic important structure. Categorical variables are presented as numbers followed by percentages. Continuous data are presented as the mean ± deviation. The tumor size and IRE ablation size were evaluated by the maximum diameters.
Results:
Thirty-two patients who underwent IRE ablation for tumor adjacent to perihepatic important structure were studied in this research. There were 39 lesions in 32 patients treated with IRE ablation. Fourteen of them (35.9%) were located adjacent to the porta hepatis, and 8 of them (20.5%) were located adjacent to the hepatocaval confluence. Subcapsular lesions accounted for 15.4% (6 of 39 lesions). The other 11 lesions were in the para gallbladder (5 of 39 lesions, 12.8%), the caudate lobe (5 of 39 lesions, 12.8%) and the colonic hepatic flexure (1 of 39 lesions, 2.6%). According to the Clavien-Dindo classification system for complications, all relative patients with cancer experienced complications below class III except one patient who developed postoperative hemorrhagic shock and improved after timely treatment. Recurrence in situ was observed in 5 of 32 (15.6%) patients. The median PFS of the patients who received IRE ablation was 384 days, and the median OS was 571 days.
Conclusion:
IRE ablation is a feasible and safe treatment strategy for tumors adjacent to perihepatic important structure. With improved equipment, optimized therapeutic parameters and long-term clinical trials, IRE will play an increasingly important role in the treatment of tumors in liver.
Insights
Irreversible electroporation (IRE) is a safe and effective treatment for liver tumors near critical structures. This study shows IRE offers good outcomes, suggesting broader clinical use for these challenging cases.
Area of Science:
- Hepatobiliary Surgery
- Interventional Oncology
- Medical Devices
Background:
- Irreversible electroporation (IRE) is a validated treatment for liver tumors.
- Tumors near vital perihepatic structures pose treatment challenges.
- Limited data exists on IRE's efficacy in these specific locations.
Purpose of the Study:
- To evaluate the clinical outcomes of IRE for liver tumors adjacent to critical perihepatic structures.
- To assess the safety and effectiveness of IRE in challenging anatomical locations.
- To provide evidence for expanding IRE's application in liver cancer treatment.
Main Methods:
- Retrospective analysis of 32 patients with tumors near perihepatic structures treated with IRE (Feb 2017-Dec 2021).
- Tumor and ablation sizes assessed by maximum diameter.
- Follow-up included contrast-enhanced CT/MRI; complications, recurrence, progression-free survival (PFS), and overall survival (OS) were evaluated.
Main Results:
- 39 lesions in 32 patients were treated; common sites included porta hepatis (35.9%) and hepatocaval confluence (20.5%).
- Complications were generally low (Clavien-Dindo < III), with one case of hemorrhagic shock.
- Recurrence was observed in 15.6% of patients; median PFS was 384 days, and median OS was 571 days.
Conclusions:
- Irreversible electroporation is a feasible and safe option for liver tumors near critical perihepatic structures.
- IRE demonstrates promising clinical outcomes in these challenging cases.
- Further research and optimized parameters may enhance IRE's role in liver cancer therapy.
