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Dott. Michele De Simone
CHIRURGIA E ONCOLOGIA
www.chirurgiaeoncologia.it
 
Dott. Michele De Simone

mail: info@chirurgiaeoncologia.it

 

Pseudomyxoma Peritonei e Tumori Mucinosi dell’Appendice

IntraPeritoneale a flusso d’Aria Pressurizzata (PIPAC)” “Chemioterapia


 

Ca Ovarico

Ca Ovarico Recidivo

Ca Colon sec look

Peritonectomia ed HIPEC nello Pseudomixoma Peritoneale

Elettroporazione irreversibile border line
 

L’elettroporazione Irreversibile (IRE) è una nuova arma per trattare i carcinomi del pancreas. La possibilità di distruggere i tessuti neoplastici conservando intatte le strutture vascolari rendono tale metodica ideale per trattare alcune neoplasie , ma soprattutto per  completare la chirurgia dei tumori del Pancreas.

I cancri pancreatici solitamente recidivano vicino ai vasi mesenterici poiché è  impossibile  asportare radicalmente microscopicamente la malattia da tali strutture nobili. Elettroporare arteria e vena mesenterica superiore  durante l’intervento dovrebbe dare maggiori garanzie. E’ in corso uno studio per valutare L’IRE come completamento ed allargamento dei margini di resezione durante intervento per Carcinoma del pancreas: da sottolineare che aggiungere l’elettroporazione allunga di poco l’intervento chirurgico.

Di seguito una comunicazione al Congresso Internazionale sull’elettroporazione svoltosi a Settembre 2015 in Slovenia

 

IRE & Pancreatic Cancer

only 20% of patients affected by pancreatic 
   adenocarcinoma could be candidate to radical
   surgery
30% of patients could not be operated  for
   important vascular involvement without distant
   metastasis (Locally advanced Pancreatic
   Cancer, LAPC
) (Callery et al., 2009).
These patients have very few therapeutic
   solutions and a very dismal prognosis (Median
   Survival: 5-11 months).

 

IRE &LAPC

•  Many locoregional therapies (Radiofrequency, Cryotherapy, Microwaves) were introduced in order to improve prognosis
•  These procedures are based on thermal injury and coagulative necrosis  and could cause injuries also to vascular, biliary, intestinal, nervous structures.
   Irreversible Electroporation (IRE) uses short electrical pulses generating nanopores on the cellular membrane those lead to cell apoptosis, but sparing extracellular structures: this permit a more selective ablation of neoplastic tissue without damaging close tissues.

 

IRE &Border Line Resectable Pancreatic Cancer (BLRPC)

•  Many R0 resection for Pancreatic Cancer are microscopic R1 (especially Retroportal Lamina) and this fact influence survival (Sigiura et al. Surgery ,2013)
  This is surely more true in BLRPC
 A new promising use of IRE is to reach a posterior margin (Retroportal Lamina) accentuation in BLRPC during  Duodeno Cephalo  Pancreatectomy (DCP)

 

Matherial and Methods

•  Perspective monoinstitutional study on IRE. (approved by our Ethical Committee).
   inclusion criteria are :
1) Patients with non-metastatic LAPC who underwent neoadjuvant chemotherapy: the case is discussed by a multisciplinary team (Surgeon, oncologist, Radiotherapist); maximum size ≤ 4 cm (exclusive IRE)
2) Patients with BLRPC after Chemotherapy (complementary IRE as further treatment to radicalsurgery to reach a posterior margin accentuation)

 


2 IRE Procedures For LAPC
 

Operative Steps

Laparotomic Access
   Use of IntraOperative UltraSound (IOUS)
 size and vascular relationship of neoplasm,
  treatment plan with software.
  We insert  needles in the peritumoral tissues and by mean of IOUS we calibrate distance and parallelism between needles
   Finally we transfer electrical pulses to neoplasm through the couples of needles.  Couples of needles could be moved to cover completely the volume of the cancer.
   Sometimes we do gastro-jejunal or bilio-jejunal anastomosis

 


5 IRE Procedures For BLRPC

 

Operative Steps.

•  We Perform the Transection of the Pancreas left to Portal vein
•  Use of IntraOperative UltraSound (IOUS) for insert 2 needles one at right of mesenteric-portal axis and the second at left of S.M.A. at a distance no more than 2-2,5 cm before to detach the uncinate process
•  Finally we transfer electrical pulses to the couple of needles.  Generally   needles could be moved to cover completely the volume of the posterior lamina
•  After IRE we complete the posterior lamina dissection and the DCP.

 

NanoKnife® IRE System

NanoKnife System consists of the veneratori
  (pictured at right), footswitch, power cord,
  and a line of single-use disposable electrodes. 
System has:
- Up to 6 outputs with programmable,
  automatic switching between each output.
-USB port to download patient data.
 
FDA 510(k) clearance for the surgical
   ablation of soft tissue.
  System also carries a
  CE mark.

 

Conclusions

Too early for conclusions on my experience.
Better patient selection in IRE for  LAPC
I hope IRE for BLRPC could  decrease local recurrences

 

 
 
 
 
PRIVACYY

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