Microwave Ablation with Percutaneous Approach for the Treatment of Pancreatic Adenocarcinoma.

Pancreatic adenocarcinoma, characterized by a late presentation and by high aggressiveness, is one of the most lethal human cancers and currently the fifth most common cause of cancer-related death in men [1]. Only 10% of the tumors are confined to the pancreas at the time of presentation, 30–40% are locally advanced, and 50% have distant metastases [1, 2]. Only approximately 20% of pancreatic cancers are found to be resectable at the time of presentation. Surgical resection is the only potentially curative treatment for pancreatic cancer [2]. Some palliative therapeutic modalities have been applied in treatment of unresectable locally advanced pancreatic carcinoma, such as chemotherapy and chemoradiation [3]. In a few patients, thermal ablative techniques, such as radiofrequency ablation (RFA) and microwave ablation (MWA), have been reported, especially in association with surgery [4, 5]. Date RS [6] reviewed the results of local ablative therapies for the treatment of pancreatic cancer; photodynamic therapy (PDT), high-intensity ultrasound (HIFU), cryoablation, and RFA may have role in ablation of pancreatic tumors. Wu et al. [7] reported encouraging results on the feasibility of HIFU ablation of pancreas tumor, but they excluded patients with carcinoma located in the head to avoid damage of the biliary duct. Photodynamic therapy has major disadvantages of organizational and technical difficulties in setting up the treatments and potential side effects, such as skin photosensitivity reaction [8]. Matsui et al. [9] performed laparotomy and radiofrequency heating in 20 patients with unresectable pancreatic carcinomas. They have reported an intraperitoneal abscess in one patient who died of septic shock. Potential benefits of these techniques include treatment of patients who are not surgical candidates and reduced morbidity compared with surgery. Ablation with microwave has several intrinsic advantages over RFA, including the capability to generate very high tissue temperature, less intraprocedural pain, larger coagulation zones, less sensitivity to tissue type and charring, improved performance near blood vessels, and no requirement of ground pads [10–12]. Recently, this technique has been proposed in different organs, such as liver, lung, and kidney [10]. However, only few cases regarding the use of MWA in pancreatic cancer have been published and they were performed under laparotomy represents the first pancreatic head cancer with the percutaneous approach treated with MWA.