IRREVERSIBLE ELECTROPORATION (IRE) – AN EVIDENCE BASED APPROACH FOR PANCREATIC DUCTAL ADENOCARCINOMA AND LIVER TUMOURS
Saturday 28 November
Synopsis: Pancreatic ductal adenocarcinoma is the fourth leading cause of tumour-related death in the Western world. Complete tumour extirpation (R0 resection) remains the best possibility for long-term survival. In view of the pressing need for optimal local disease control, irreversible electroporation (IRE) has emerged as a novel, non-thermal ablative therapy of pancreatic cancer. Electrodes are placed around the tumour, and a pulsed, direct current is delivered. This results in disruption of the lipid bilayer and creation of small nanopores in the cell membrane. This causes apoptosis and cell death without heating of the tissues, which spares the extracellular matrix and proteins. The role of IRE in the treatment of pancreatic cancer is versatile. In patients with LAPC (locally advanced pancreatic cancer) the addition of IRE to conventional therapies results in substantially prolonged survival compared to historical controls. Intraoperative IRE margin accentuation and pancreatico-duodenectomy in resectable pancreatic cancer could minimize the risk of local recurrence and improve outcome. We propose to present the results of a novel Pilot study (20 consecutive patients compared with controls) aimed to assess if margin accentuation using IRE results in reduction in margin positivity during pancreatico-duodenectomy procedure for resectable pancreatic head tumours. The study also assessed whether margin accentuation using IRE during pancreaticoduodenectomy translates into improved overall survival and disease free survival. IRE has also been used as an ablative tool for primary liver cancer (hepatocellular carcinoma) and metastatic liver disease (example – colorectal cancer, neuroendocrine). The advantage of the use of IRE is that it could be used safely near vascular and bile ducts without risk of thermal damage. We propose to present the experience from King’s College Hospital of over 70 patients in the use of IRE for liver tumours. In summary, IRE is a novel ablative technology that has applications in pancreatic ductal adenocarcinoma and also primary and metastatic liver disease. Our experience suggests that IRE is a complex technique with a steep learning curve. It is safe and effective and is valuable in the treatment of liver tumours that are unsuitable or considered high risk for conventional thermal ablation. Results from the pilot study doing margin accentuation using IRE in resectable pancreatic cancer has shown reduction in margin positivity and we propose a multi-centre randomised trial.
Presentation title: IRE – an evidence based approach in the treatment of pancreatic and liver tumors
Presenter: Dr Krishna Menon, King’s College Hospital
Mr.Krishna Menon is a Consultant Liver Transplant and Hepatopancreatobiliary Surgeon at the King’s College Hospital NHS Foundation Trust, London. He is an experienced liver transplant and laparoscopic HPB surgeon having performed laparoscopic liver resections including major hepatectomies and complex non-anatomical liver resections and contributed patients to international randomised trials. He also has a major interest in laparoscopic resection/ablation of primary hepatocellular carcinoma (as primary treatment and bridge to liver transplant). He has also had a vast experience in laparoscopic pancreatic resections having performed the first total laparoscopic pancreaticoduodenectomy in the UK in 2005. He has also set up the novel Irreversible Electroporation (Nanoknife) treatment for pancreatic and liver cancer in conjunction with the interventional radiologist at King’s College Hospital and runs international workshops to train surgeons in the use of the technology. Mr.Menon’s research interests have been related to liver and pancreatic cancer and has over 120 peer reviewed publications and over 250 presentations at National, European and International meetings. Mr.Menon is the Clinical Lead for Liver Transplant Surgery and Educational and Training Lead for Liver transplantation and HPB surgery at King’s College Hospital and also the National Councillor for Liver Transplantation on the British Transplantation Society and the Great Britain Chapter of the IHPBA.
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