Evaluation of Resistance as a Measure of Successful Tumor Ablation During Irreversible Electroporation of the Pancreas
Evaluation of Resistance as a Measure of Successful Tumor Ablation During Irreversible Electroporation of the Pancreas
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DOI：
10.1016/j.jamcollsurg.2013.10.013
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发表时间：
2014-02-01
影响因子：
5.2
通讯作者：
Martin, Robert C. G., II
中科院分区：
文献类型：
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作者：
Dunki-Jacobs, Erik M.;Philips, Prejesh;Martin, Robert C. G., II
背景技术背景：术中评价使用不可逆电穿孔（IRE）成功消融胰腺肿瘤是困难的，其次是缺乏视觉确认。IRE发生器通过报告电流（安培数）提供反馈，可用于计算肿瘤组织电阻的变化。本研究的目的是确定是否可以使用电阻来预测成功的肿瘤消融在IRE胰腺cancer.Study设计：所有患者接受胰腺IRE从2010年3月至2012年12月进行了评估，使用前瞻性数据库。术中信息，包括消融过程中肿瘤阻力的变化和阻力曲线的斜率，被用来评估肿瘤消融的有效性方面的局部失败或复发（LFR）和无病生存期（DFS）。中位随访时间为23个月。17例患者在IRE后3、6或9个月时出现局部失败或复发。肿瘤组织阻力的变化和阻力曲线的斜率在预测LFR方面均具有显著性（分别为p = 0.02和p = 0.01）。复发患者的中位局部无病生存期为5.5个月，而未复发患者为12.6个月（p = 0.03）。无论是肿瘤组织电阻的平均变化，也不是阻力曲线的斜率显着预测整体DFS.CONCLUSIONS：平均变化，肿瘤组织电阻和阻力曲线的斜率可以在术中评估成功的肿瘤消融术在IRE。需要更大的样本量和更长的随访时间来确定这些参数是否可以用于预测DFS。（美国科尔外科杂志2014; 218：179-187。(C)2014年美国外科医生学会）
BACKGROUND: Intraoperative evaluation of successful pancreatic tumor ablation using irreversible electroporation (IRE) is difficult secondary to lack of visual confirmation. The IRE generator provides feedback by reporting current (amperage), which can be used to calculate changes in tumor tissue resistance. The purpose of the study was to determine if resistance can be used to predict successful tumor ablation during IRE for pancreatic cancers.STUDY DESIGN: All patients undergoing pancreatic IRE from March 2010 to December 2012 were evaluated using a prospective database. Intraoperative information, including change in tumor resistance during ablation and slope of the resistance curve, were used to evaluate effectiveness of tumor ablation in terms of local failure or recurrence (LFR) and disease-free survival (DFS).RESULTS: A total of 65 patients underwent IRE for locally advanced pancreatic cancer. Median follow-up was 23 months. Local failure or recurrence was seen in 17 patients at 3, 6, or 9 months post IRE. Change in tumor tissue resistance and the slope of the resistance curve were both significant in predicting LFR (p = 0.02 and p = 0.01, respectively). The median local disease-free survival was 5.5 months in patients who had recurrence compared with 12.6 months in patients who did not recur (p = 0.03). Neither mean change in tumor tissue resistance nor the slope of the resistance curve significantly predicted overall DFS.CONCLUSIONS: Mean change in tumor tissue resistance and the slope of the resistance curve could be used intraoperatively to assess successful tumor ablation during IRE. Larger sample size and longer follow-up are needed to determine if these parameters can be used to predict DFS. (J Am Coll Surg 2014; 218: 179-187. (C) 2014 by the American College of Surgeons)