Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark.
Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
Surg Endosc. 2024 Feb;38(2):697-705. doi: 10.1007/s00464-023-10557-1. Epub 2023 Nov 28.
The development of new perioperative treatment modalities to activate the immune system in colorectal cancer might have a beneficial effect on reducing the risk of recurrence after surgery. Calcium electroporation is a promising treatment modality that potentially modulates the tumor microenvironment. The aim of this study was to evaluate the safety of the procedure in the neoadjuvant setting in localized left-sided colorectal cancer (CRC).
The study included patients with potentially curable sigmoid or rectal cancer with no indication for other neoadjuvant treatment. Patients were offered calcium electroporation as a neoadjuvant treatment before elective surgery. Follow-up visits were conducted on the preoperative day before elective surgery, POD2, POD14, and POD30, with an evaluation of adverse events, impact on elective surgery, clinical examination, and quality of recovery.
Endoscopic calcium electroporation was performed as an outpatient procedure in all 21 cases, with no procedure-related complications reported. At follow-up, five adverse events were registered, two of which were classified as serious adverse events. Surgery was performed as planned in 19 patients (median time to surgery, 8 days), and the final two patients underwent surgery with a delay due to adverse events (14 and 33 days). No significant impact on the quality of recovery scores nor inflammatory markers were seen before and after calcium electroporation, nor baseline and POD30.
Endoscopic calcium electroporation is a safe and feasible procedure in patients with potentially curable CRC. The study showed limited side effects and limited impact on the following elective surgical resection.
开发新的围手术期治疗方法以激活结直肠癌的免疫系统可能有助于降低手术后复发的风险。钙电穿孔是一种有前途的治疗方法，可能调节肿瘤微环境。本研究旨在评估钙电穿孔在局部左侧结直肠癌（CRC）新辅助治疗中的安全性。
该研究纳入了无其他新辅助治疗指征的潜在可治愈的乙状结肠或直肠腺癌患者。患者在选择性手术前被提供钙电穿孔作为新辅助治疗。在术前一天、术后第 2 天、第 14 天和第 30 天进行随访，评估不良事件、对选择性手术的影响、临床检查和恢复质量。
21 例患者均在门诊进行了内镜下钙电穿孔，无与操作相关的并发症发生。随访时，有 5 例不良事件被记录，其中 2 例被归类为严重不良事件。19 例患者（中位手术时间 8 天）按计划进行了手术，最后 2 例患者由于不良事件而延迟手术（14 天和 33 天）。钙电穿孔前后及基线和第 30 天，恢复质量评分和炎症标志物均未见明显变化。
内镜下钙电穿孔在有潜在可治愈 CRC 的患者中是一种安全可行的方法。该研究显示副作用有限，对后续的选择性手术切除影响有限。
