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Ascites After Irreversible Electroporation of the Liver and Pancreas
*Asha Zimmerman, Kevin Charpentier
Brown University, Providence, RI
Objective: To determine the rate of ascites following Irreversible Electroporation (IRE) of liver and pancreas tumors.
Design: Case series.
Setting: A university associated tertiary referral hospital.
Patients: The charts of all patients undergoing IRE at a single institution were reviewed. Eight tumors were ablated in 6 patients.
Intervention: IRE was performed by a single surgeon using ultrasound guidance during an open operation.
Main Outcome Measure: Percentage of patients who developed ascites after IRE.
Results: Eight tumors were ablated in 6 patients: 4 hepatocellular carcinomas, 3 colorectal metastases, and 1 locally advanced pancreatic adenocarcinoma. Four of 6 patients had cirrhosis. Portal vein thrombosis developed in 1 patient after pancreas IRE. There were no deaths following IRE. Mean follow up was 10 months (range 3-17). All (6/6) patients developed clinically significant ascites and 5 required diuretic therapy. One patient required paracentesis. Two patients developed pleural effusions, one of which required thoracentesis. Ascites was controlled or resolved in 5/6 patients and remained clinically significant only in one patient who underwent IRE 3 months prior. Of the liver lesions ablated, there was 100% (7/7) response to IRE ablation with no evidence of residual disease or local recurrence.
Conclusions: IRE is transitioning from the developmental phase to the exploratory phase of surgical innovation as described by the Balliol collaboration, where a focus on patient safety is paramount. IRE appears to be associated with the development of ascites. In our early experience, this ascites appears to be independent of cirrhosis and portal vein thrombosis and is responsive to therapy.
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