Basic Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2022; 14(8): 1499-1509
Published online Aug 15, 2022. doi: 10.4251/wjgo.v14.i8.1499
Safety and feasibility of irreversible electroporation for the pancreatic head in a porcine model
Li Yan, Bin Liang, Jian Feng, Hang-Yu Zhang, Hao-Sheng Chang, Bing Liu, Yong-Liang Chen
Li Yan, Bin Liang, Hang-Yu Zhang, Hao-Sheng Chang, Bing Liu, Yong-Liang Chen, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepetobiliary Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
Jian Feng, Department of Hepatopancreatobiliary Surgery, Peking University Shougang Hospital, Beijing 100144, China
Author contributions: Yan L and Chen YL designed and coordinated the study; Yan L, Liang B, and Feng J performed the experiments, and acquired and analyzed the data; Zhang HY, Chang HS, and Liu B interpreted the data; Yan L and Feng J wrote the manuscript; Liang B and Feng J should be regarded as co-first authors; all authors approved the final version of the article.
Institutional review board statement: The manuscript does not include human experiments.
Institutional animal care and use committee statement: The operational procedures for the animal experiments were approved by the Institutional Animal Care and Use Committee (IACUC) of PLA General Hospital (No. 2016-D12-02).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE Guidelines, and the manuscript was prepared and revised according to the ARRIVE Guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Liang Chen, MD, PhD, Director, Doctor, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepetobiliary Surgery, The First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chenyongl301@163.com
Received: April 6, 2022
Peer-review started: April 6, 2022
First decision: May 10, 2022
Revised: May 12, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 15, 2022
Processing time: 126 Days and 3.7 Hours
ARTICLE HIGHLIGHTS
Research background

Irreversible electroporation (IRE) is a relatively novel local ablation technique based on the delivery of repeated and high-frequency microsecond- to millisecond-long electrical pulses to a target tissue. It is characterized by non-thermal damage and no heat sink effect, thus able to protect vital anatomic structures such as pancreatic ducts and vessels in close proximity within the targeted organs. These qualities make IRE an attractive alternative for treatment of locally advanced pancreatic cancer. Recently, this novel ablation has been tested successfully on normal and malignant lesions in the prostate, liver, lung, and pancreas in animal models, and even in human subjects; however, the safety and feasibility of IRE for lesions in the pancreatic head are still controversial.

Research motivation

Studies on the local and systemic effects of IRE for pancreatic head of large animals remain limited. Elucidating the short- and long-term effects of IRE on the pancreatic head will be an essential step in demonstrating its safety and feasibility before further implementation in clinical patients. We carried out an animal experiment to examine this procedure.

Research objectives

This study aimed to examine the safety and feasibility of IRE for the pancreatic head in a porcine model.

Research methods

In total, eight Landrace pigs were randomly divided into four groups, with two pigs per group, corresponding to different observation time points (1 h, day 1, day 7, and day 28 after IRE surgery), and underwent IRE ablation of the pancreatic head successfully. Laboratory testing including white blood cell (WBC) count and serum amylase before IRE with follow-up laboratory analysis and pathological examination at 1, 7, 14, and 28 d postablation were performed.

Research results

The effects of IRE on the pancreatic head were characterized by transiently elevated WBC and amylase, and acute damage to targeted area including pancreatic tissue and the duodenum which was confirmed by pathological observations in the early phase after ablation. Vascular endothelial cells and pancreatic duct epithelial cells in ablation zone were also positive for terminal deoxynucleotidyl transferase dUTP nick end labeling staining while the structure was still intact in long-term observation, indicating that the risk of short-term damage should be paid more attention to prevent severe perioperative complications.

Research conclusions

IRE ablation to the pancreatic head is safe and feasible without long-term damage to the surrounding vital structures while risks of stress injuries in acute phase should be brought to our attention.

Research perspectives

In vitro studies of IRE ablation on various human pancreatic cancer cell types should be conducted to optimize parameters and techniques of pancreatic IRE ablation in clinical settings to keep safe and further studies are needed to investigate the mechanism of tissue repair and regeneration after IRE.