Research advances of nanoknife ablation combined with programmed death-1/programmed death ligand-1 in treatment of pancreatic cancer and relative immunological mechanisms / 中国介入影像与治疗学

Although the special tumor microenvironment of pancreatic cancer is not conducive to immunotherapy, nanoknife ablation can partial reverse immunosuppression, therefore is the only way of ablation for pancreatic cancer. Results of animal studies showed that the treatment of pancreatic cancer with nanoknife ablation combined with programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) might prolong the survival time. The research advances of the mechanisms of nanoknife ablation combined with PD-1/PD-L1 in treatment of pancreatic cancer and the relative immunological mechanisms were reviewed in this article.

Safety and efficacy of nanoknife ablation for unresectable hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To evaluate the safety and curative effect of nanoknife ablation in the treatment of unresectable hilar cholangiocarcinoma.Methods 15 patients with unresectable hilar cholangiocarcinoma received nanoknife ablation treatment from March 2016 to May 2017.The clinical variables of the patients before and after operation were analyzed.Results The operations in all the patients carred out successfully.Cardiac arrhythmia occurred in some patients during the operation accidentally.The level of CA19-9 increased significantly on postoperative day 1,3 and then gradually decreased in 13 patients;one patient had no significant change of CA19-9,and the data for another patient was always in the normal range.The liver function of all patients gradually improved after operation,and the level of total bilirubin,AST and ALT showed a downward trend.The myocardial enzyme in all the patients increased on postoperative day 1,then returned to normal within the following 5 days.Postoperative complications included atrial fibrillation (1 case),upper gastrointestinal bleeding (1 case).The recanalization rates of the bile duct at 2 weeks,1 month,and 2 months after surgery were 66.6％,86.6％,and 93.3％,respectively.Conclusion Nanoknife ablation has superior safety,noteworthy efficacy and less complications in the treatment of the unresectable hilar cholangiocarcinoma in the short term.

Locally advanced pancreatic cancer:treatment with Nanoknife percutaneously under guidance of ultrasound and effectiveness evaluated by contrast enhanced ultrasonography / 中华超声影像学杂志

Objective To explore the treatment of locally advanced pancreatic cancer(LAPC)by Nanoknife,and the demonstrations on contrast enhanced ultrasonography(CEUS)after the procedures. Methods Four patients were enrolled.Each of them was percutaneously inserted 3-5 Nanoknife electrodes to ablate the lesions with 2-3 sessions under the guidance of ultrasound.After the procedures,CEUS, contrast enhanced CT,contrast enhanced MRI or computed tomography angiography (CTA) were performed to assess the efficacy.Results All patients uneventfully were able to tolerate the high-voltage Nanoknife procedures.However,the endurable pain or discomfort in abdomen was complained.For one patient with obstructive jaundice and mild liver dysfunction,pancreatic amylase in serum increased slightly at the first day after treatment.Furthermore,C response protein in serum elevated,and biliary tract infection happened at the third day.Moreover,thromboses in portal and splenic vein were found at the seventh day.The survival time for all cases were 3-8 months.According to the findings of CEUS,a well-defined no contrast enhancement was detected at ablative zone for all the patients within one week.Yet, contrast enhancement was sporadically detected at the periphery in 3 patients 1-2 months late.Meanwhile, on contrast enhanced CT or MRI,an area of absent enhancement was also depicted at the ablation zone with heterogeneously decreased enhancement at periphery of the lesion.Base on CTA findings,local stenosis of splenic vein and superior mesenteric vein with varices of collateral vascularity were found in one patient at the fiftieth day,and superior mesenteric vein obstruction accompanied by varices of collateral vascularity was also found in another patient at the seventieth day.Conclusions For patients with LAPC,Nanoknife treatment is a safe and convenient procedure that can be percutaneously completed under the guidance of ultrasound.Along with enhanced CT,MRI or CTA,CEUS is a promising way to evaluate the efficacy of this procedure.

Perioperative safety and effect of irreversible electroporation in the management of locally advanced pancreatic carcinoma / 中华肝胆外科杂志

Objective To evaluate the perioperative safety and effect of irreversible electroporation (IRE) in the treatment of locally advanced pancreatic carcinoma (LAPC).Methods Twenty patients with imaging and cytohystological diagnosis of unresectable locally advanced pancreatic carcinoma were enrolled to undergo IRE treatment.The perioperative IRE-related complications were primarily analyzed to evaluate the safety of the procedure.The tumor reduction and biological response were analyzed through CT/MRI imaging and serous level of CA19-9.Results All patients were successfully treated with an average tumor size of(4.2 ± 0.6) cm and an average procedure time of (52.0 ± 23.3) minutes.Three intraoperative procedure-related complications were observed (15.0％) including two transient hypertension and one transient superventricular tachycardia.Six postoperative complications were described including two Grade A pancreatic fistula,one infection of incision,one portal vein thrombosis,one gastrointestinal hemorrhage and two functional delayed gastric emptying.The symptom remission rate was 73.7％ and lower serum CA19-9 level was recorded in all patients at discharge.Conclusions IRE is a safe and feasible procedure in the treatment of LAPC, and a reasonable operation strategy of IRE is helpful to consolidate the safety and efficacy.

Nanoknife ablation of the pancreas in vivo experiment / 中华肝胆外科杂志

Objective Nanoknife,also called irreversible electroporation,is a new technique of tissue ablation.Short,microsecond electrical pulses with high voltage are applied to the cell membrane,causing pores to form within the membrane and finally leading to cell death.The current study was to investigate the efficacy and safety of the nanoknife in the ablation of the healthy pig pancreas.Methods Three healthy pigs underwent open pancreatic tissue ablation with nanoknife,and blood leukocytes and amylase were detected before and after treatment.Three pigs were sacrificed and gross specimens were collected on day 5,day 10 and day 15 after the procedure,respectively.HE staining and TUNEL staining were conducted and tissue,cellular and subcellular structures were observed under the ordinary microscope and transmission electron microscopy.Results Three experimental pigs recovered well after the procedure.No significant adhesions were found surrounding the pancreatic tissue,and the ablation zone was slightly harder.Transiently increased leukocyte count and amylase level were observed after the ablation,which decreased to the normal level on day 3 after treatment.Under light microscope,the pancreatic tissues in ablation zone appeared to be significantly different from the normal surrounding regions,with more cell death and more apoptotic cells detected by TUNEL staining.The subcellular structure changes also changed under electron microscope.But the main pancreatic duct and its large branches,together with arteriovenous distributions did not change much.Conclusions Nanoknife pancreatic tissue ablation can induce irreversible damage.In the ablation area,pancreatic duct and vascular structures are kept intact.Within a reasonable voltage range and appropriate electrical pulses setting,nanoknife ablation is safe in vivo experiment.