Outcomes in treatment of locally advanced pancreatic ductal adenocarcinoma with irreversible electroporation at a single institution

Presenter: Daniel Wolbrom MD, MPH | Stony Brook University Hospital Background: Locally advanced pancreatic ductal adenocarcinoma (LAPD) presents with the unique feature of non-metastatic, unresectable disease. Data show that LAPD 5-year overall survival is about 12%, approaching all-stage overall pancreatic cancer survival of less than 10%. Therefore, the utilization of an alternative local surgical therapy, such as irreversible electroporation (IRE), a non-thermal ablative technique, may confer survival advantage with minimal morbidity. Methods: Single institution retrospective study of all patients diagnosed with pancreatic cancer from 2012-2020, treated with IRE and analyzed for perioperative and oncologic outcomes. Statistical analysis was done using the Mann-Whitney non parametric test and Kaplan-Meier survival analysis. Results: Twenty two patients received 24 procedures, of which 2 patients received repeat IRE procedures. The median procedure duration was 174.5 (IQR 123.5-212.3) minutes, median blood loss 27.5 (IQR 20-87.5) cc, and intraoperative transfusion occurred in 4.2% of cases. Nine cases included the formation of a gastrojejunostomy. None of the patients required ICU admission. Time to regular diet and length of stay (LOS) medians were 3 (IQR 2-3.75) and 4.5 (IQR 4-6.75) respectively. LOS was not affected by the performance of gastrojejunostomy (median 5 vs 4 days, p: 0.089), which affected the diet initiation (median 3 vs 2 days, p: 0.016). Perioperative 30 day mortality was null, with perioperative 30 day morbidity (Clavien-Dindo III/IV) was 12.5%, including a patient who returned to the OR. All patients were discharged to home and readmission rate was 8.2%. Long term outcomes were significant for 1, 2, and 5 year overall survival of 72.7%, 27.3%, and 22.7% respectively, with median survival 15.2 months. Preoperative chemotherapy was received by 90.1%, whereas all the patients with known follow up received postoperative chemotherapy. Conclusion: IRE appears to be a promising treatment modality for LAPD. While there is a lack of randomized clinical evidence in the literature, our study is on par with encouraging results previously published. Further investigation is warranted for this technique.