Safety and Efficacy of Irreversible Electroporation in Locally Advanced Pancreatic Cancer: An Evaluation from a Surgeon’s Perspective

SIMPLE SUMMARY: Pancreatic cancer is the fourth most lethal human malignancy. One-third of pancreatic cancer cases are diagnosed as locally advanced pancreatic cancer (LAPC); however, the optimal treatment of LAPC remains to be elucidated. Irreversible electroporation (IRE) has been applied as the treatment LAPC, but the safety and efficacy of IRE against LAPC need to be further clarified. In this study, we evaluate the safety and efficacy of IRE against LAPC, as well as exploring its impact on the immune response. The rate of major complications in the IRE group was similar to that in those undergoing pancreaticoduodenectomy with concurrent vascular resection (VR group), but higher than patients undergoing palliative surgery (PS group). The overall survival of the IRE group was shorter than that of the VR group, but longer than that of the PS group. The survival advantage in IRE-treated patients may be attributed to tumor ablation and immune modulation effects. Therefore, IRE is a feasible treatment for patients with LAPC. ABSTRACT: Irreversible electroporation (IRE) has emerged as a promising treatment for patients with locally advanced pancreatic cancer (LAPC). Therefore, in this study, we evaluate the safety and efficacy of IRE against LAPC, as well as exploring its impact on anti-tumor immunity. A retrospective analysis was conducted in consecutive patients at a single institution. Eligible patients were assigned to IRE, palliative surgery (PS), or vascular resection (VR) groups, according to their respective treatments. The IRE group consisted of LAPC patients. One-to-one propensity score matching was performed, in order to compare the incidence of complications and median overall survival (mOS). Serum and intratumoral cytokines, as well as intratumoral immune cells, were analyzed in order to identify changes in immunity after IRE. A total of 210 patients were included. After matching, the rate of major complications (Clavien–Dindo III–V), intra-abdominal hemorrhage, and re-intervention in the IRE group were similar to those in the VR group (p > 0.05). The mOS of the IRE group (13.0 months) was shorter than that of the VR group (15.0 months), but longer than that of the PS group (8.0 months) (p < 0.05). Patients in the IRE group had elevated serum levels of immunogenic cytokines, including IL-2, IL-6, and TNF-α, which were related to anti-tumor immunity. The survival advantage in IRE-treated patients was attributed to tumor ablation and immune modulation effects. Overall, IRE can be considered a feasible treatment for patients with LAPC.