A 44-year-old Mumbai man with recurrent pancreatic cancer has now undergone treatment using an advanced technique called irreversible electroporation (IRE), commonly known as NanoKnife, which uses precisely delivered electrical pulses to destroy cancer cells while aiming to spare surrounding critical structures.
The patient, Sourav Dutta, had undergone a Whipple procedure, a major operation to remove the head of the pancreas along with parts of surrounding organs, about two-and-a-half years ago. During follow-up, scans revealed that the cancer had returned around two major blood vessels supplying vital abdominal organs.
Although there was no evidence of distant spread, the tumour's location made repeat surgery particularly challenging. The patient was advised to undergo chemotherapy, but the tumour remained closely associated with the blood vessels. As his health deteriorated, he sought further evaluation and was considered suitable for IRE NanoKnife treatment.
The procedure was performed at Nanavati Max Super Speciality Hospital in Mumbai by a team that included Dr Ganesh Nagarajan, Vice Chairman, HPB and GI Surgery and Dr Aniruddha Kulkarni, Principal Director, Interventional Radiology.
Unlike conventional cancer treatments that use radiation, drugs or heat to destroy tumour tissue, IRE uses short, high-voltage electrical pulses to damage the membranes of cancer cells.
As per doctors, during the procedure, specialised needle-like electrodes are positioned in and around the tumour under image guidance. Electrical pulses are then delivered between the electrodes, creating microscopic pores in the membranes of targeted cells. When the damage is irreversible, the affected cells lose their ability to maintain normal cellular functions and eventually die.
The technique is called irreversible electroporation because the damage to the cell membranes is permanent, unlike reversible electroporation, in which cells can recover after temporary membrane changes.
One of the key features of IRE is that it is a non-thermal ablation technique. Treatments such as radiofrequency ablation and microwave ablation rely on heat to destroy tumour tissue, while cryoablation uses extreme cold. These approaches can be difficult to use in certain locations because of the risk of injury to nearby structures.
IRE, by contrast, is designed to destroy cells without relying primarily on heat or cold. This can make it useful for selected tumours located close to major blood vessels, bile ducts and other delicate structures.
The technique aims to preserve the supporting framework of the surrounding tissue, although the degree of preservation and the risk of complications depend on the location of the tumour and the procedure.
This is particularly relevant in pancreatic cancer, where tumours may lie close to major arteries and veins.
Pancreatic cancer is difficult to treat partly because of the location of the pancreas deep within the abdomen and its close relationship with major blood vessels and neighbouring organs. When the disease returns after surgery, treatment decisions become more complex, particularly if the recurrent tumour involves or closely abuts critical vessels.
In Dutta's case, the absence of detected distant spread and the tumour's location were among the factors considered during evaluation for the procedure.
According to Dr Nagarajan, "the technology uses precisely delivered electrical pulses to destroy cancer cells while avoiding the significant thermal injury associated with heat-based ablation techniques. This makes it a potential option for carefully selected patients whose tumours are situated close to vital structures."
The entire procedure was performed without open surgery, and Dutta was discharged within two days.
However, IRE is not suitable for every patient with pancreatic cancer, doctors warn. Its use depends on the tumour's size and location, the extent of the disease, the patient's overall condition and previous treatments. It also carries risks, including bleeding, infection and injury to nearby structures.
The procedure does not eliminate the possibility of cancer recurrence.
Dr Kulkarni said, "Recurrent pancreatic cancer requires careful assessment because treatment options may become more limited after the patient has already undergone major surgery and other therapies." He also emphasised the importance of regular follow-up and timely imaging as part of long-term cancer care.
While NanoKnife is not a universal solution for pancreatic cancer, it represents an additional local treatment option for selected patients in whom conventional surgery may be unsafe because of the tumour's proximity to critical blood vessels.
