# Use of Irreversible Electroporation in Pancreatic Cancer Patients: A Multi-Center Experience

## TL;DR

This study evaluates irreversible electroporation in pancreatic cancer patients, finding it more suitable for unresectable cases than for margin accentuation during surgery.

## Contribution

The study provides multi-center evidence on IRE outcomes in pancreatic cancer, suggesting its role in unresectable disease but not in margin accentuation.

## Key findings

- IRE for margin accentuation in borderline resectable cancer had high complication and mortality rates.
- IRE in unresectable pancreatic cancer showed relatively safe local disease control with 27.3% 24-month survival.
- R0 resection was achieved in 63.6% of margin accentuation cases, but local recurrence occurred in 24.2% of patients.

## Abstract

Pancreatic ductal adenocarcinoma has a poor prognosis, and irreversible electroporation (IRE) has emerged as a promising non-thermal ablation technique for locally advanced and borderline resectable pancreatic cancer. This multi-center retrospective study evaluated outcomes in 35 patients treated with IRE for either tumor destruction in unresectable cases or margin accentuation during resection in borderline resectable cases. Our findings highlight the need for careful patient selection and suggest IRE may play a role in managing unresectable disease but not in margin accentuation during surgery. Future research should refine indications for IRE and could inform clinical guidelines, influencing surgical decision-making and improving treatment strategies for pancreatic cancer.

Background: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival rate of 10%. Irreversible electroporation (IRE), a non-thermal ablative technique, may improve outcomes in locally advanced (LAPC) and borderline resectable pancreatic cancer (BRPC). This multi-center retrospective study aims to evaluate postoperative complications, 90-day mortality, and survival following IRE. Methods: 35 pancreatic cancer patients were treated with IRE between 2015 and 2023 across three Belgian hospitals. IRE was performed for tumor destruction in unresectable LAPC (n = 13) (IRE-LAPC) and for margin accentuation during resection in BRPC (n = 22) (IRE-MA). Primary endpoints were 90-day mortality, complications, and survival (only 33 patients included); secondary endpoints included metastases, local recurrence, and R0-resection rates. Results: Postoperative complications occurred in 23.1% (IRE-LAPC) and 68.2% (IRE-MA) of patients. Overall survival at 24 months was 27.3% (IRE-LAPC) and 27.3% (IRE-MA). Median survival time was 12.7 months (IRE-LAPC) and 13.3 months (IRE-MA). Six patients (17.1%) died within 90 days. Metastasis occurred in 51.5% of patients after a median time of 9.8 months. Local recurrence was seen in 24.2% of patients after a median time of 7.5 months. R0 resection was achieved in 63.6% (IRE-MA). Discussion: IRE for margin accentuation in BRPC is associated with relatively high morbidity and mortality rates and cannot be considered beneficial. In unresectable LAPC, IRE appears relatively safe for local disease control. Further research should clarify patient selection and optimize its therapeutic role.