Intraoperative adverse events during Irreversible Electroporation - A call for caution

• Published in: The American journal of surgery Vol. 212; no. 4; pp. 715 - 721
• Main Authors: Kambakamba, Patryk, MD, Bonvini, John M., MD, Glenck, Michael, MD, Castrezana López, Liliana, MD, Pfammatter, Thomas, MD, Clavien, Pierre-Alain, MD, PhD, FACS, DeOliveira, Michelle L., MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016; Elsevier Limited
• Subjects: Ablation; Aged; Anesthesia; Arrhythmias, Cardiac - etiology; Blood pressure; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular Diseases - complications; Celiac Artery; Complications; Diabetes; Digestive System Neoplasms - surgery; Electrocardiography; Electroporation; Electroporation - instrumentation; Family medical history; Female; Heart attacks; Heart rate; Humans; Hyperkalemia - etiology; Hypertension; Hypertension - etiology; Intraoperative Complications; Kidney diseases; Localization; Logistics; Male; Middle Aged; Multivariate Analysis; Pancreatic cancer; Patient safety; Patients; Retroperitoneal Neoplasms - surgery; Risk Factors; Surgery; Tumors; Ultrasonic imaging; complications; Standard operating procedure; ablation; USG; Computer tomography; IQR; LAPC; Hepato- pancreato- biliary; IAE; anesthesia; CT; SOP; Intraoperative adverse events; Interquartile range; Locally advanced pancreatic cancer; Intraoperative Ultrasound; electroporation; HPB; IRE; Irreversible electroporation; Electroporation; Anesthesia; Complications; Ablation
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.07.001

Abstract Background Irreversible electroporation is increasingly used for treatment of solid tumors, but safety data remains scarce. This study aimed to describe intraoperative adverse events associated with irreversible electroporation in patients undergoing solid tumor ablation. Methods We analyzed demographic and intraoperative data for patients (n=43) undergoing irreversible electroporation for hepato-pancreato-biliary and retroperitoneal malignancies (2012-2015). Adverse events were defined as cardiac, surgical or equipment-related. Results Adverse events (n=20; 47%) were primarily cardiac (90%, n=18), including blood pressure elevation (77%, n=14/18) and arrhythmia (16%; n=7/43). All but one were managed medically; one patient with arrhythmia required termination of ablation. Bleeding and technical problems with the equipment occurred in one patient each. Multivariable analysis revealed previous cardiovascular disease and needle placement close to the celiac trunk associated with increased likelihood for cardiac events. Conclusion Intraoperative cardiac adverse events are common during irreversible electroporation, but rarely impair completion of the procedure.