Percutaneous Irreversible Electroporation for Portal Vein Tumor Thrombus: A Case Report
Portal vein tumor thrombus (PVTT), with an incidence rate of 44% to 62.2%, is a major risk factor for hepatocellular carcinoma (HCC). Hepatocellular carcinoma complied by PVTT is classified into an advance stage (stage C), as recommended by the Barcelona Clinic Liver Cancer Staging.1 The treatment strategies for PVTT patients include surgical resection, liver transplantation, transarterial chemoembolization, local ablation or radiotherapy, and sorafenib administration; however, which among these strategies produces the optimal effects remains controversial. Local tumor controlling is necessary for survival.2 Based on the principle of multidisciplinary therapy, local thermal ablation is recommended for nonresectable tumor with type I/II/III PVTT in case that patient had Child-Pugh A liver function by Chinese expert consensus, while this approach may be associated with inevitable injuries to adjacent major structures. The heat-sink effect and indiscriminate tissue damage from thermal ablation may result in incomplete ablation and subsequent short-time local recurrence.3
Irreversible electroporation (IRE) is a newly developed nonthermal ablative technique wherein nanosized cytomembrane pores are created by electrical impulses to promote the apoptosis of target cancer cells while preserving the major vasculature and duct system.4 This technique is extensively used in some refractory cancers, such as liver, kidney, prostate, lung, and pancreas cancers. At present, literature search on PubMed and Ovid demonstrates that the usage of intraoperative, laparoscopic, or percutaneous IRE in HCC with PVTT is extremely rare. Therefore, we report the novel use of IRE for the percutaneous local ablation of PVTT without heat-sink effect and thermal injury to surrounding PV branches.