Fritz Stefan, Sommer Christof M, Longerich Thomas, Kuhn-Neureuther Clemens, Radeleff Boris, Werner Jens, Hackert Thilo
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Department of General, Visceral and Transplantation Surgery, Katharinenhospital, Klinikum Stuttgart, Germany.
Langenbecks Arch Surg. 2017 May;402(3):465-473. doi: 10.1007/s00423-017-1579-4. Epub 2017 Apr 4.
Irreversible electroporation (IRE), a nonthermal injury ablation technique, has been shown to be effective and safe in various organs, such as in the kidney, liver, prostate, or in pancreas. In contrast to radiofrequency or microwave ablation, IRE is also effective in the neighborhood of major vessels. Many human cancers reveal lymphatic spread. The present study aimed to evaluate technical feasibility and safety of IRE in lymphatic tissue. To our knowledge, this is the first report showing successful IRE of lymph nodes in a standardized porcine survival model.
A total of ten pigs were divided into two study groups. Five animals received ECG-gated IRE of mesenteric lymph nodes of the small bowel and were sacrificed 2 h after ablation. Another five animals were followed up for 7 days. Clinical parameters, laboratory and abdominal imaging by contrast-enhanced computed tomography, as well as histology were obtained from all animals at different time points.
During and after IRE ablation, no cardiocirculatory side effects were noted in any of the animals. In the acute phase experiments, no damage to adjacent organs and no thermal injuries were seen following IRE. One hundred twenty minutes after ablation, no significant laboratory changes were observed. In the survival group, all animals recovered quickly and showed normal activity and feeding habits indicating a minimal pain level. Seven days after IRE ablation, a significant increase in white blood cell count was observed, while creatinine, urea, or hemoglobin remained unchanged. Computed tomography revealed a hypodense lesion following IRE already at 2 h. Histopathology showed coagulation necrosis of the treated lymph nodes with preservation of the lymph node capsule.
This porcine survival model shows that IRE can safely and effectively be performed in lymph nodes. Thus, IRE might display a novel approach for therapy of lymph node metastasis. Further clinical studies are needed to evaluate the oncologic outcome of IRE ablation in lymph node metastasis.
不可逆电穿孔（IRE）是一种非热损伤消融技术，已被证明在肾脏、肝脏、前列腺或胰腺等各种器官中有效且安全。与射频或微波消融不同，IRE在大血管附近也有效。许多人类癌症会出现淋巴转移。本研究旨在评估IRE在淋巴组织中的技术可行性和安全性。据我们所知，这是第一份在标准化猪存活模型中成功进行淋巴结IRE的报告。
总共10头猪被分为两个研究组。5只动物接受小肠系膜淋巴结的心电图门控IRE，并在消融后2小时处死。另外5只动物随访7天。在不同时间点从所有动物获取临床参数、实验室检查、对比增强计算机断层扫描的腹部成像以及组织学检查结果。
在IRE消融期间及之后，未在任何动物中观察到心脏循环方面的副作用。在急性期实验中，IRE后未观察到对相邻器官的损伤和热损伤。消融120分钟后，未观察到明显的实验室变化。在存活组中，所有动物恢复迅速，活动和饮食习惯正常，表明疼痛程度最低。IRE消融7天后，观察到白细胞计数显著增加，而肌酐、尿素或血红蛋白保持不变。计算机断层扫描显示IRE后2小时淋巴结就出现低密度病变。组织病理学显示治疗后的淋巴结出现凝固性坏死，淋巴结包膜保留。
这种猪存活模型表明IRE可以在淋巴结中安全有效地进行。因此，IRE可能为淋巴结转移的治疗提供一种新方法。需要进一步的临床研究来评估IRE消融在淋巴结转移中的肿瘤学结果。
