Irreversible Electroporation for Colorectal Liver Metastases

• Published in: Techniques in vascular and interventional radiology Vol. 18; no. 3; pp. 159 - 169
• Main Authors: Scheffer, Hester J., MD, Melenhorst, Marleen C.A.M., MD, Echenique, Ana M., MD, Nielsen, Karin, MD, PhD, van Tilborg, Aukje A.J.M., MD, van den Bos, Willemien, MD, Vroomen, Laurien G.P.H., MD, van den Tol, Petrousjka M.P., MD, PhD, Meijerink, Martijn R., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2015
• Subjects: ablation; Ablation Techniques - adverse effects; Ablation Techniques - instrumentation; Cell Death; colorectal cancer; Colorectal Neoplasms - pathology; Electroporation - instrumentation; Electroporation - methods; Equipment Design; Hematology, Oncology and Palliative Medicine; Humans; image-guided; irreversible electroporation; liver metastasis; Liver Neoplasms - secondary; Liver Neoplasms - surgery; liver tumor; Positron-Emission Tomography; Postoperative Complications - etiology; Radiology; Risk Factors; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - instrumentation; Surgery, Computer-Assisted - methods; Tomography, X-Ray Computed; Treatment Outcome; liver tumor; liver metastasis; colorectal cancer; irreversible electroporation; image-guided; ablation
• ISSN: 1089-2516; 1557-9808
• DOI: 10.1053/j.tvir.2015.06.007

Image-guided tumor ablation techniques have significantly broadened the treatment possibilities for primary and secondary hepatic malignancies. A new ablation technique, irreversible electroporation (IRE), was recently added to the treatment armamentarium. As opposed to thermal ablation, cell death with IRE is primarily induced using electrical energy: electrical pulses disrupt the cellular membrane integrity, resulting in cell death while sparing the extracellular matrix of sensitive structures such as the bile ducts, blood vessels, and bowel wall. The preservation of these structures makes IRE attractive for colorectal liver metastases (CRLM) that are unsuitable for resection and thermal ablation owing to their anatomical location. This review discusses different technical and practical issues of IRE for CRLM: the indications, patient preparations, procedural steps, and different “tricks of the trade” used to improve safety and efficacy of IRE. Imaging characteristics and early efficacy results are presented. Much is still unknown about the exact mechanism of cell death and about factors playing a crucial role in the extent of cell death. At this time, IRE for CRLM should only be reserved for small tumors that are truly unsuitable for resection or thermal ablation because of abutment of the portal triad or the venous pedicles.