Electroporation for Metastatic Liver Cancer

Irreversible electroporation (IRE) is a useful type of ablation for treating nonsurgical candidates with colorectal liver metastases. This modality’s unique and nonthermal mechanism of inducing cellular apoptosis has certain advantages over conventional thermal ablation, including immunity from the “heat-sink” effect, preservation of vasculature and biliary ducts within the ablation zone, and protection of thermosensitive critical structures (e.g., bowel) near the ablation zone. In both retrospective and prospective studies, IRE has achieved non-inferior outcomes compared to thermal modalities, such as radiofrequency or microwave ablation, in the treatment of colorectal liver metastasis. The literature has demonstrated the relevance of ablation for colorectal liver metastasis, especially regarding the therapeutic benefits and ease of re-intervention following ablation. Current guidelines describe ablation as an effective, minimally invasive approach to treat colorectal liver metastasis. IRE has extended the option of ablation to certain patients where thermal ablation is contraindicated. It is more technically demanding than other types of ablations and entails meticulous planning, multiple probes, general anesthesia requirements, and careful patient selection. The nonthermal mechanism of IRE minimizes the incidence of common complications of thermal ablation that result from heat-related injury. Studies have found that IRE has a complication rate and efficacy similar to that of thermal ablation for the treatment of colorectal liver metastasis.