Spiers Harry V M, Lancellotti Francesco, de Liguori Carino Nicola, Pandanaboyana Sanjay, Frampton Adam E, Jegatheeswaran Santhalingam, Nadarajah Vinotha, Siriwardena Ajith K
Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK.
Cancers (Basel). 2023 Apr 24;15(9):2428. doi: 10.3390/cancers15092428.
Irreversible electroporation (IRE) is a non-thermal form of ablation based on the delivery of pulsed electrical fields. It has been used to treat liver lesions, particularly those in proximity to major hepatic vasculature. The role of this technique in the portfolio of treatments for colorectal hepatic metastases has not been clearly defined. This study undertakes a systematic review of IRE for treatment of colorectal hepatic metastases.
The study protocol was registered with the PROSPERO register of systematic reviews (CRD42022332866) and reports in compliance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The Ovid MEDLINE, EMBASE, Web of Science and Cochrane databases were queried in April 2022. The search terms 'irreversible electroporation', 'colon cancer', 'rectum cancer' and 'liver metastases' were used in combinations. Studies were included if they provided information on the use of IRE for patients with colorectal hepatic metastases and reported procedure and disease-specific outcomes. The searches returned 647 unique articles and the exclusions left a total of eight articles. These were assessed for bias using the methodological index for nonrandomized studies (MINORS criteria) and reported using the synthesis without meta-analysis guideline (SWiM).
One hundred eighty patients underwent treatment for liver metastases from colorectal cancer. The median transverse diameter of tumours treated by IRE was <3 cm. Ninety-four (52%) tumours were adjacent to major hepatic inflow/outflow structures or the vena cava. IRE was undertaken under general anaesthesia with cardiac cycle synchronisation and with the use of either CT or ultrasound for lesion localisation. Probe spacing was less than 3.2 cm for all ablations. There were two (1.1%) procedure-related deaths in 180 patients. There was one (0.5%) post-operative haemorrhage requiring laparotomy, one (0.5%) bile leak, five (2.8%) post-procedure biliary strictures and a zero incidence of post-IRE liver failure.
This systematic review shows that IRE for colorectal liver metastases can be accomplished with low procedure-related morbidity and mortality. Further prospective study is required to assess the role of IRE in the portfolio of treatments for patients with liver metastases from colorectal cancer.
不可逆电穿孔（IRE）是一种基于脉冲电场传递的非热消融形式。它已被用于治疗肝脏病变，特别是那些靠近主要肝血管的病变。该技术在结直肠癌肝转移治疗组合中的作用尚未明确界定。本研究对IRE治疗结直肠癌肝转移进行了系统评价。
研究方案已在系统评价的PROSPERO注册库（CRD42022332866）中注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）进行报告。2022年4月查询了Ovid MEDLINE、EMBASE、Web of Science和Cochrane数据库。搜索词“不可逆电穿孔”、“结肠癌”、“直肠癌”和“肝转移”组合使用。如果研究提供了关于IRE用于结直肠癌肝转移患者的信息，并报告了手术和疾病特异性结果，则纳入研究。搜索返回647篇独特文章，排除后共留下8篇文章。使用非随机研究方法学指数（MINORS标准）评估这些文章的偏倚，并按照无荟萃分析的综合报告指南（SWiM）进行报告。
180例患者接受了结直肠癌肝转移治疗。IRE治疗的肿瘤中位横径<3 cm。94个（52%）肿瘤毗邻主要肝流入/流出结构或腔静脉。IRE在全身麻醉下进行，采用心动周期同步，并使用CT或超声进行病变定位。所有消融的探针间距均小于3.2 cm。180例患者中有2例（1.1%）与手术相关的死亡。有1例（0.5%）术后出血需要剖腹手术，1例（0.5%）胆漏，5例（2.8%）术后胆管狭窄，IRE后肝衰竭发生率为零。
本系统评价表明，IRE治疗结直肠癌肝转移的手术相关发病率和死亡率较低。需要进一步的前瞻性研究来评估IRE在结直肠癌肝转移患者治疗组合中的作用。
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