Preface
Surgical resection is the treatment of choice for most malignant tumors. Dangerous site malignant tumor usually refers to the tumor adjacent to or invading the surrounding large blood vessels, nerves and other important tissues, and such tumors often lose the chance of surgery due to the high risk of surgery and postoperative complications. Physical ablation is a common local treatment method, which causes tumor necrosis through high or low temperature causing protein denaturation, but the temperature change may also damage blood vessels, nerves and other important tissues. Nanoknife is a new ablation technique, which is a "non-thermal ablation". It achieves ablation by releasing high-voltage current pulses, causing irreversible nano-scale perforation of cells, resulting in apoptosis. The aim of this study is to summarize the short-term efficacy and postoperative complications of 23 cases of malignant tumors at risk sites ablated by Nanoknife, and to evaluate the safety and efficacy of Nanoknife ablation.
The purpose of quoting some parts of the Short-term Effect and Safety of Ultrasound Guided Irreversible Electroporation in the Treatment of Malignant Tumor Located in Dangerous Position here is to popularize the emerging technology of nanoblade ablation, so that readers can have a clearer understanding of nanoblade and understand the indispensable and important role of nanoblade ablation surgery in tumor treatment.
Short-term Effect and Safety of Ultrasound Guided Irreversible Electroporation
in the Treatment of Malignant Tumor Located in Dangerous Position
Lin Manxia，Xie Xiaoyan，Kuang Ming, Xu Ming,Tian Wenshuo Zhang Xiaoer lu Mingde
Chinese J Ultrasound Med Vol．33 No．5 May 2017
[Departments of Ultrasound，the First Affiliated Hospital，Sun Yat-Sen University，Guangzhou]
Abstract
Objective：To evaluate the short-term effect and safety of ultrasound guided irreversible electropora—tion(IRE)in the treatment of malignant tumor in dangerous position
Methods ：Methods Twenty-three malignant tumors in dangerous position were treated by IRE under ultrasound guidance．Clinical data before and after ablation was retrospectively analyzed．Safety of IRE procedure was evaluated by analyzing the perioperative complication；CT images and serum tumor marker were analyzed to evaluate the treatment effect．
Results：Malignant tumors enrolled in this study including 1 6(69．5％)pancreatic malignant tumors，3(1 3．1％)retroperitoneal malignant tumor，2(8．7％)primary liver carcinoma and 2(8．7％)malignant tumors in maxillofacial region．All patients were successfully treated with IRE ablation．Six(26．1％)complication were described during ablation including five(21．7％)transient hypertension and one(4．3％)continuous fluctuation of blood pressure．Eight(34．8％)postoperative complication were observed including one(4．3％)lower gastrointestinal obstruction，4(1 7．4％)delayed gastric empty and 3(1 3．0％)eardiovas—cular complication．The pain remission rate was 93．3％in pain-suffered patients；lower serum tumor marker level was observed in 53．8％patients one month after ablation．
Conclusions：IRE is a safe and promising procedure in the management of malignant tumors located in dangerous position．
Materials and Methods
From April to October 2016, 23 patients with malignant tumors underwent ultrasound-guided Nanoknife ablation in our hospital, 16 males and 7 females, aged 34 to 75 years, with an average of (57.9±9.0) years. Inclusion criteria: (1) preoperative assessment of unresectable malignant tumor; (2) ≤5.0 cm; (3) PS score 0-1; (4) ASA score ≤2; (5) prothrombin activity >50% and platelet count >50×109/L. Exclusion criteria: (1) arrhythmia or pacemaker installation; (2) epilepsy; (3) metal implant at the treatment site; (4) 2 history of myocardial infarction within 2 months; (5) continuous anticoagulation therapy that cannot be stopped.
Results
All patients completed Nanoknife ablation successfully, with intraoperative bleeding of 0-400 ml. 1 case (4.3%) of pancreatic cancer had persistent fluctuations in heart rate and blood pressure during ablation, which were relieved after ablation was suspended; 5 cases (21.7%) had transient intraoperative blood pressure elevation without ablation suspension. 8 cases (34.7%) had postoperative Clavien- The patients had no symptoms of maxillofacial nerve damage after ablation in 2 patients with maxillofacial tumors. All adverse reactions and complications resolved with symptomatic treatment. The number of postoperative hospitalization days ranged from 4 to 25 d, with a mean of (12.2±5.3) d. Pancreatic malignancy: none of the patients had pancreatic leakage after surgery; 7 patients (43.8%) had elevated serum amylase on the first postoperative day and 10 patients (62.5%) had elevated serum lipase on the first postoperative day, and serum lipase and amylase all returned to normal levels within one week after surgery.
Short-term efficacy：In 15 cases of pancreatic cancer who presented with right upper abdominal pain before surgery, one case (6.7%) had no significant pain relief after surgery and underwent retroperitoneal ganglion anhydrous ethanol injection again, while the remaining 14 cases (93.3%) had pain relief within one week. 13 patients with pancreatic malignancy had elevated CA-199 before surgery, and 7 cases (53.8%) had decreased CA-199 one month after surgery, 1 case (7.7%) had no significant change, and 5 cases (38.5%) had mild elevation. Two patients with hepatocellular carcinoma had lower postoperative tumor markers than before surgery. Enhanced CT 1 month after surgery showed that the scope of ablation foci was larger than the preoperative tumor scope, and there were no enhancement areas within the ablation foci, and in some cases, mild enhancement bands appeared around the periphery, and the filling in the lumen of large vessels around the ablation foci was complete (Figure 1).
（Figure 1 Ultrasound image before and after nanoskimming ablation of locally progressive pancreatic cancer）
Discussion
Nanoknife ablation is an emerging tumor ablation technique, the mechanism of which is irreversible electroporation (IRE) of cell membranes. High-voltage short-pulse direct current emits a powerful electric field, which acts on the cell membrane and causes changes in the transmembrane potential, resulting in nano-scale perforation of the cell membrane and increased cell membrane permeability leading to apoptosis. Compared with traditional ablation methods (such as radiofrequency ablation, microwave ablation, etc.), Nanoknife ablation has a high tissue selectivity and causes little damage to the blood vessel wall and nerves which lack double-layer lipid structure. Therefore, theoretically, compared with the traditional ablation technology, Nanoknife ablation is more suitable for the treatment of tumors in dangerous areas.
Conclusion
Nanoknife ablation of malignant tumors in dangerous sites is clinically safe and effective. Nanoknife ablation technology provides a new and effective local treatment for malignant tumors in dangerous sites that cannot be surgically removed.
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Li Manxia Department of Ultrasound Medicine The First Affiliated Hospital of Sun Yat-sen University Associate Chief Physician
Primary Academic Appointment Tumor ablation: involving the liver, pancreas, kidney, thyroid, parathyroid and breast; Routine intervention: ultrasound-guided puncture/biopsy/tube placement/sclerotherapy of various organ lesions; Diagnosis: ultrasound diagnosis of the abdomen and superficial organs, especially in the differentiation of benign and malignant lesions of the liver, pancreas and biliary tract and diagnosis of difficult cases.
Research Interests Precision ablation and comprehensive treatment of tumors; nano-knife ablation of hepatocellular carcinoma and pancreatic cancer at high-risk sites; ultrasound monitoring of multi-stage evolution of cirrhosis to hepatocellular carcinoma; prevention and management of post-ablation complications. |
Currently, a multi-center clinical registration trial of the Steep Pulse Therapeutic Apparatus (Nanoknife) for the ablation treatment of pancreatic malignant tumors is underway in several hospitals across the country. For more information, please leave a message in the background or contact the following person by phone.
Contact person:Manage Zuo from Alpmed
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