Margin ACcentuation for resectable Pancreatic cancer using Irreversible Electroporation – Results from the MACPIE-I study |
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| Institution: | 1. Institute of Liver Studies, King''s College Hospital, London, SE5 9RS, United Kingdom;2. Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom;3. Aretaeio Hospital, Nicosia, 2024, Cyprus;4. Liver Critical Care Unit, Institute of Liver Studies, King''s College Hospital, London, SE5 9RS, United Kingdom;5. Department of Oncology, Guy''s and St Thomas'' NHS Foundation Trust & KCH-FT, London, United Kingdom;1. Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden;2. Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden;1. Department of Surgery, University of Louisville, USA;2. School of Medicine, University of Louisville, USA;1. University of Louisville, Hiram C. Polk Jr, MD Department of Surgery, Division of Surgical Oncology, Louisville, KY, USA;2. Augusta University Medical Center, Department of Surgery, Section of Surgical Oncology, Augusta, GA, USA;3. Johns Hopkins University, Department of Surgery, Division of Surgical Oncology, Baltimore, MD, USA;4. University of Alabama, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL, USA;5. University of California San Diego Moores Cancer Center, Gastrointestinal Cancer Unit, San Diego, CA, USA;6. National Taiwan University Hospital, Department of Surgery, Zhongzheng, Taipei, Taiwan |
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| Abstract: | IntroductionMargin accentuation (MA) using Irreversible electroporation (IRE) offers an unique opportunity to reduce the R1 resections in resectable pancreatic cancer (RPC). This study aims to assess the rate of margin positivity using IRE for MA during pancreaticoduodenectomy (PD) for resectable pancreatic head tumours.Materials and methodsFollowing ethical approval, MA using IRE was carried out in 20 consecutive patients to posterior and superior mesenteric vein (SMV) margin, and the pancreatic neck, prior to the PD resection. The control group (non-IRE; n = 91) underwent PD without MA over the study period, March 2018 to March 2020.ResultsThere was no difference between the two groups in terms of patients’ age, gender, pre-op biliary drainage, site of malignancy or pre-operative TNM stage. The overall margin positive rate for IRE group was lesser (35.0%) when compared to non-IRE group (51.6%; p = 0.177), with significantly less posterior pancreatic margin positivity (5.0% vs. 25.3%; p = 0.046). When only treated margins (SMA margin excluded) were compared, the IRE group had significantly lower margin positive rates (20.0% vs. 51.6%; p = 0.013). There was no difference between the two groups in terms of intra- or post-operative complications. With a median follow-up of 15.6 months, the median DFS and OS for IRE and non-IRE groups were 17 and 18 months (p = 0.306) and 19 and 22 months (p = 0.227) respectively.ConclusionOur pilot study confirms the safety of MA using IRE for RPC, with reduction in margin positivity. These results as a proof of concept are promising and need further validation with a randomised controlled trial. |
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| Keywords: | Margin accentuation Irreversible electroporation Pancreatic cancer Resectable IRE |
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