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

Dimitrios Moris, Nikolaos Machairas, Diamantis I. Tsilimigras, Anastasia Prodromidou, Aslam Ejaz, Matthew J Weiss, Natasha Hasemaki, Evangelos Felekouras, Timothy M. Pawlik

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StatePublished - Jan 1 2019

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Electroporation
Pancreatic Neoplasms
Therapeutics
Survival
Morbidity
Mortality
Palliative Care
MEDLINE
Meta-Analysis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer. / Moris, Dimitrios; Machairas, Nikolaos; Tsilimigras, Diamantis I.; Prodromidou, Anastasia; Ejaz, Aslam; Weiss, Matthew J; Hasemaki, Natasha; Felekouras, Evangelos; Pawlik, Timothy M.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalReview article

Moris, Dimitrios ; Machairas, Nikolaos ; Tsilimigras, Diamantis I. ; Prodromidou, Anastasia ; Ejaz, Aslam ; Weiss, Matthew J ; Hasemaki, Natasha ; Felekouras, Evangelos ; Pawlik, Timothy M. / Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer. In: Annals of Surgical Oncology. 2019.
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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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AU - Moris, Dimitrios

AU - Machairas, Nikolaos

AU - Tsilimigras, Diamantis I.

AU - Prodromidou, Anastasia

AU - Ejaz, Aslam

AU - Weiss, Matthew J

AU - Hasemaki, Natasha

AU - Felekouras, Evangelos

AU - Pawlik, Timothy M.

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N2 - 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.

AB - 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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