NanoKnife Surgery in Israel

Pancreatic cancer is the fourth leading cause of death worldwide. As this type of tumour is usually diagnosed in late stages, traditional surgical intervention is possible in only about 15 to 20%  of cases. In 40% of cases the disease has already metastasized, and in 30 to 40% of cases it has invaded the adjacent organs and spread into the vascular and lymphatic systems. These patients, whose disease had spread into adjacent blood vessels (such as the abdominal artery, portal vein and superior mesenteric artery and vein) were previously considered inoperable. New technological developments, however, have given them a new hope of 5-year survival. One of these new methods is the NanoKnife surgery, which uses electricity to kill cancer cells.

What is NanoKnife Surgery?

NanoKnife ablation, also known as IRE (irreversible electroporation), is a method of tumour destruction using high-voltage electric current (up to 3000V in 100 msec). This irreversibly damages the malignant cells’ membranes, causing miniature pores to form. The dead cells are then evacuated from the patient’s body by the immune system (similarly to apoptosis). As the area of ablation is not exposed to extreme heat, healthy adjacent tissues are not damaged during treatment. Additionally, as IRE does not affect collagen and elastin, neither blood vessels nor bile ducts are harmed during the procedure. The muscle tissues are mildly affected but usually recover within 2 weeks.

The procedure is performed under US-guidance and specialized NanoKnife IRE software. Due to increased complexity, an abdominal incision (approx. 10 cm long, along the central line) is required for pancreatic surgeries. The operative procedure itself usually takes no more than an hour (not counting pre-operative electrode placement). Following the surgery you will need to remain in the hospital for 3 to 4 days. It is also possible to combine to combine a surgical resection with an IRE for ablation of surgical margins when blood vessels are involved. The effectiveness of this procedure is approaching 100%. Technology that will allow this surgery to be performed as a minimally invasive procedure is currently being developed.

Additionally, NanoKnife surgery has been used to treat rectal malignancies. The technology allows specialists to destroy tumour cells in areas important for sexual function, and treat cases of tumour invasion into bone, sphincter or prostate. At present it is performed when other operative interventions are contraindicated or when pelvic exenteration, which has a high mortality rate, is required.

Indications for NanoKnife Treatment:

• Inoperable [[pancreatic cancer]] (locally advanced with vascular invasion), which has stopped growing after no less than 4 chemotherapy cycles.
• When there is a need to destroy tumour cells at the resection margins.
• Primary or secondary liver tumours (following chemo) that can’t be removed d/t their localization or when the patient’s condition does not allow carrying out such a surgery.
• Primary or recurring rectal tumours, to achieve clean surgical margins at hard-to-reach areas, in cases of pelvic spread and for the purpose of preserving sphincters and preservation of sexual function. Additionally, it can be used as palliative therapy to reduce pain and bleeding.

Potential complications:

• Thrombosis d/t local edema. While local edemas are usually clinically insignificant it is important to have a CTA or Doppler US scan 3 weeks following the NanoKnife treatment.
• Minimal pancreas perforation
• Late postoperative surgery (may develop within the first 3 post-operative weeks), might require an angiographic embolization.

Contraindications:

• Metastatic pancreatic cancer.

Relative contraindications:

• Presence of a pacemaker (needs to be disabled or reprogrammed prior to procedure).
• Presence of a metallic stent near the area which is to be ablated (needs to be removed prior to surgery)
• Cardiac arrhythmia

The surgery is performed under general anesthesia.

In Israel NanoKnife surgery is performed by highly-trained gastric surgeons in cases of pancreatic and rectal cancers, as well as cancers of the liver.