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. 2018 Feb 28;9(21):15732-15739.
doi: 10.18632/oncotarget.24596. eCollection 2018 Mar 20.

Radiofrequency assisted pancreaticoduodenectomy for palliative surgical resection of locally advanced pancreatic adenocarcinoma

Jayant Kumar  1 , Isabella Reccia  1 , Mikael H Sodergren  1 , Tomokazu Kusano  1 , Artur Zanellato  1 , Madhava Pai  1 , Duncan Spalding  1 , Dimitris Zacharoulis  2 , Nagy Habib  1
Affiliations

Radiofrequency assisted pancreaticoduodenectomy for palliative surgical resection of locally advanced pancreatic adenocarcinoma

Jayant Kumar et al. Oncotarget. .

Abstract

Background: Despite careful patient selection and preoperative investigations curative resection rate (R0) in pancreaticoduodenectomy ranges from 15% to 87%. Here we describe a new palliative approach for pancreaticoduodenectomy using a radiofrequency energy device to ablate tumor in situ in patients undergoing R1/R2 resections for locally advanced pancreatic ductal adenocarcinoma where vascular reconstruction was not feasible.

Results: There was neither postoperative mortality nor significant morbidity. Each time the ablation lasted less than 15 minutes. Following radiofrequency ablation it was observed that the tumor remnant attached to the vessel had shrunk significantly. In four patients this allowed easier separation and dissection of the ablated tumor from the adherent vessel leading to R1 resection. In the other two patients, the ablated tumor did not separate from vessel due to true tumor invasion and patients had an R2 resection. The ablated remnant part of the tumor was left in situ.

Conclusion: Whenever pancreaticoduodenectomy with R0 resection cannot be achieved, this new palliative procedure could be considered in order to facilitate resection and enable maximum destruction in remnant tumors.

Method: Six patients with suspected tumor infiltration and where vascular reconstruction was not warranted underwent radiofrequency-assisted pancreaticoduodenectomy for locally advanced pancreatic ductal adenocarcinoma. Radiofrequency was applied across the tumor vertically 5-10 mm from the edge of the mesenteric and portal veins. Following ablation, the duodenum and the head of pancreas were removed after knife excision along the ablated line. The remaining ablated tissue was left in situ attached to the vessel.

Keywords: palliation; pancreatic ductal adenocarcinoma; pancreaticoduodenectomy; radiofrequency ablation.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors report no conflicts of interest, but Nagy Habib is a shareholder and director of EMcision Limited, which has developed the Habib 4X, one of the devices cited in this article not manufactured or currently marketed by this company.

Figures

Figure 1
Figure 1. Ablated and desiccated tumor has been gently swept off the adherent vessel
Figure 2
Figure 2. Sequential application of RF probes to create parallel ablation lines adjacent to the tumor vessel interface
Figure 3
Figure 3. Resection with scalpel over the ablated region of tumor at tumor vessel interface
See this image and copyright information in PMC

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