Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
Hepatobiliary Pancreat Dis Int. 2019 Apr;18(2):117-124. doi: 10.1016/j.hbpd.2019.01.001. Epub 2019 Jan 4.
Irreversible electroporation (IRE) is a novel ablative technique for hepatobiliary and pancreatic cancers. This review summarizes the data regarding the safety and efficacy of IRE in the treatment of hepatobiliary and pancreatic cancers.
Studies were identified by searching PubMed and Embase for articles published in English from database inception through July 31, 2017. For inclusion, each clinical study had to report morbidity and survival data on hepatobiliary and pancreatic cancers treated with IRE and contain at least 10 patients. Studies that met these criteria were included for analysis. Two authors assessed each clinical study for data extraction. The controversial parts were resolved through discussion with seniors.
A total of 24 clinical studies were included. Fourteen focused on hepatic ablation with IRE comprising 437 patients with 666 lesions of different tumor types. Two patients (0.5%) died after the IRE procedure. Morbidity of hepatic ablation with IRE ranged from 7% to 35%. Most complications were mild. Complete response for hepatic tumors was reported as 57%-97%. Ten studies with 455 patients focused on pancreatic IRE. The overall mortality of IRE in pancreatic cancer was 2%. Overall severe morbidity of IRE in pancreatic cancer ranged from 0 to 20%. The median overall survival after IRE ranged from 7 to 23 months. Patients treated with IRE combined with surgical resection showed a longer overall survival.
IRE significantly improves the prognosis of advanced hepatobiliary and pancreatic malignances, and companied with less complications. Hence, IRE is a relatively safe and effective non-thermal ablation strategy and potentially recommended as an option for therapy of patients with hepatobiliary and pancreatic malignances.
不可逆电穿孔（IRE）是一种用于肝胆胰腺癌症的新型消融技术。本综述总结了关于 IRE 治疗肝胆胰腺癌症的安全性和疗效的数据。
通过在 PubMed 和 Embase 上搜索，从数据库建立到 2017 年 7 月 31 日发表的英文文章，确定了研究。纳入标准为每项临床研究都必须报告接受 IRE 治疗的肝胆胰腺癌症的发病率和生存率数据，并且至少包含 10 例患者。符合这些标准的研究被纳入分析。两位作者评估了每一项临床研究的数据提取情况。有争议的部分通过与资深人士讨论解决。
共纳入 24 项临床研究。其中 14 项专注于 IRE 肝消融，包括 437 例不同肿瘤类型的 666 个病灶患者。IRE 术后有 2 例患者（0.5%）死亡。IRE 肝消融的发病率为 7%至 35%。大多数并发症为轻度。肝肿瘤的完全缓解率为 57%至 97%。10 项研究涉及 455 例胰腺 IRE 患者。IRE 在胰腺癌中的总死亡率为 2%。IRE 在胰腺癌中的总严重发病率为 0 至 20%。IRE 后总体生存中位数为 7 至 23 个月。接受 IRE 联合手术切除的患者总生存率更长。
IRE 显著改善了晚期肝胆胰腺恶性肿瘤的预后，且并发症较少。因此，IRE 是一种相对安全有效的非热消融策略，可能被推荐为治疗肝胆胰腺恶性肿瘤患者的选择。
