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Impact Of Margin Accentuation With Intraoperative Irreversible Electroporation On Local Recurrence In Resected Pancreatic Cancer
*Eric Schoen, *Prejesh Philips, *Charles R Scoggins, *Michael E Egger, Robert CG Martin
University of Louisville, Louisville, KY

Objective:R0 resection for pancreatic adenocarcinoma is considered standard of care, but unfortunately not always achieved. Local recurrence is one of the most common types of recurrence, and it occurs in approximately 33% of patients undergoing pancreatic resection. Irreversible Electroporation(IRE) is a novel ablation technology that can be used intraoperatively during pancreatic resection to sterilize the surgical margins in a technique called margin accentuation(MA). The purpose of this study was to evaluate the rates of local recurrence in patients with borderline resectable pancreatic cancer after Pancreatectomy with or without IRE with MA. Methods:Prospective data for pre-operative Stage 2B(Borderline Resectable) and Stage 3 patients from our IRB approved database was evaluated for 75 patients who successfully underwent Pancreatectomy with IRE MA and then compared to patients who underwent pancreatectomy(N=71) alone from 3-2010 to 11-2020. Results: Both IRE MA and Pancreatectomy groups were similar for BMI, Charleston Comorbidity Index, and gender. The IRE MA group had a significant greater pre-op Stage III(IRE 83% vs Panc Only 51%,p=0.0001), with similar tumor location(head 64% vs 72%), and tumor size(median 2.9 vs 2.8). Neo-Adjuvant/Induction chemotherapy and prior radiation therapy was similar in both groups(IRE MA 89% vs 72%). Surgical therapy included a greater percentage of pancreaticoduodenectomy in the resection group only. Despite the greater stage, and great percentage of margin positivity(IRE MA 27% vs 20%), the rates of local recurrence were similar(Table).The mean disease-free interval for local recurrence from time of diagnosis was similar(IRE 15.8 vs 16.5 Panc only, p=ns) and time of treatment (IRE 9.4 vs 10.5 Panc only, p=ns). Overall survival was improved with the IRE and MA group with a mean of 34.2 months in the IRE MA group vs 27.9 months in the pancreatic only group. Conclusions:IRE with MA is safe and effective in stage 2B and stage 3 pancreatic adenocarcinomas that are technically resectable. Despite higher margin positivity rates the time to local recurrence and the effects of recurrence were the same in the pancreatectomy group alone.


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