Chapters authored
Irreversible Electroporation in Pancreatic Cancer
Pancreatic cancer is the deadliest of the gastrointestinal tract with 5-year survival rates of less than 5%. Given common asymptomatic early disease course, most patients (50%) present with an already metastatic disease, while only 20% can undergo potentially curative resection. The remaining 30% present with locally advanced disease, defined as extended vascular encasement, where the risk of surgical therapy often outweighs its benefits. Traditional thermal local ablative modalities (RFA, MWA, or cryotherapy) have the disadvantage that they are not applicable in proximity to vital vascular structures, which are abundant in the peripancreatic region. Irreversible electroporation (IRE) is an emerging non-thermal alternative that induces apoptosis of tumor cells by the delivery of short repetitive impulses of high-voltage electric current. Given its mostly non-thermal modality, IRE is not hampered by a heat-sink effect and is applicable with little risk around vascular structures, bile and pancreatic ducts. Recent research suggests that local tumor destruction through IRE improves overall survival, progression-free survival and quality of life in patients with locally advanced pancreatic cancer.
Part of the book: Advances in Pancreatic Cancer
Computer Assistance in the Minimally Invasive Ablation Treatment of Pancreatic Cancer
The insertion of ablation needles towards pancreatic tumors demands excellent anatomical knowledge and interdisciplinary skills from the medical professional. While the placement of a single needle next to the structures at risk surrounding the pancreas is considered a challenging task, irreversible electroporation requires multiple needles to be placed in parallel at a specific location. Minimally invasive procedures complicate the already ambitious procedure, yet the ablation method bears potential to increase the overall survival for patients with locally advanced pancreatic cancer. Current studies require more clinical evidence regarding the efficacy of irreversible electroporation in pancreatic cancer by means of randomized controlled, multicenter trials. However, the ablation treatment is currently applied in expert centers only, which is due to the complex task of the needle placement. Computer-assisted surgery has shown its potential in different fields of applications to improve the targeting of diseased tissue and the confidence of the medical professional. The application of computer-assisted needle navigation for pancreatic cancer ablation holds the prospect to make the procedure more reproducible and safer.
Part of the book: Challenges in Pancreatic Cancer