Experimental study of the safety of pancreas cryosurgery: the comparison of 2 different techniques of cryosurgery

Local cryotherapy on the pancreas with pancreatic necrosis: Results of the experimental study

Background. Acute pancreatitis retains its leading position in the structure of urgent abdominal pathology, maintaining a high postoperative mortality, despite the emergence of new methods of surgical treatment.

The aim of the study: to evaluate pathomorphological changes in the pancreas, surrounding organs and tissues, clinical manifestations in dynamics after local cryotherapy on the pancreas in animals with experimental pancreatic necrosis for subsequent use of the method in clinical practice.

Material and methods. An experimental study was performed on Wistar rats, in the main group, pancreatic necrosis was simulated with subsequent cryotherapy, in the control group, pancreatic necrosis was simulated and simple pancreatic mobilization was performed, in the third group, cryotherapy was performed on an unchanged gland. With the help of modern statistical methods, the effectiveness and safety of cryotherapy techniques were evaluated.

Results. The optimal duration of cryoapplication is an interval of 3–4  seconds at a temperature of –195.75 °C, it is not accompanied by the formation of a cryonecrosis zone, promotes the regeneration of acinuses, does not damage the accumulation of endocrine cells, interrupting the course of pancreonecrosis, does not lead to a fatal outcome, a pronounced adhesive process, other serious intraabdominal complications.

Conclusion. Cryotherapy on the pancreas in experimental pancreatic necrosis in  the  optimal temperature-time regime is accompanied by significantly lower mortality, is a safe technique and can be tested in clinical practice for the treatment of patients with this pathology. 

A Review of Therapeutic Ablation Modalities

Understanding basic science and technical aspects is essential for scientists and engineers to develop and enhance ablative modalities, and for clinicians to effectively apply therapeutic ablative techniques. An overview of ablative modalities, anatomical locations, and indications for which ablations are performed is presented. Specifically, basic concepts, parameter selection, and underlying biophysics of tissue injury of five currently used therapeutic ablative modalities are reviewed: radiofrequency ablation (RFA), cryoablation (CRA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), and chemical ablation (CHA) (ablative agents: acetic acid, ethanol, hypertonic sodium chloride, and urea). Each ablative modality could be refined for expanding applications, either independently or in combination, for future therapeutic use.

Cryosurgery for pancreatic cancer

The procedure of pancreatic cryosurgery is performed with intraoperative or percutaneous approaches. Based on current data and our initial experience, cryoablation appears to be a feasible, potentially safe and promising option in patients with locally advanced and unresectable pancreatic cancer. It is suggested that there are almost no known contraindications to the use of cryosurgery for pancreatic cancer. For most patients with pancreatic cancer, cryosurgery can substitute conventional surgery.

Comprehensive surgical management of pancreatic cancer

Pancreatic cancer is a malignancy with a very poor prognosis. Currently, surgery-based comprehensive management may be the only treatment able to significantly improve long-term survival. Radical resection is the first choice for pancreatic cancer patients. Unfortunately, less than 20% of patients are found to have resectable tumors at the time of diagnosis. In addition, only few people can acquire long-term survival even after radical resection because of recurrence and metastasis after surgery. Therefore, surgery-based comprehensive management, including iodine-125 seed implantation, sustained release 5-fluorouracil, argon-helium cryosurgery, radiofrequency ablation, immunotherapy, and regional intra-arterial infusion chemotherapy, may improve the survival and life quality of pancreatic cancer patients.