title: Radiofrequency ablation of the pancreas with and without intraluminal duodenal cooling in a porcine model.
abstract: OBJECTIVE
  To determine the short-term outcome of radiofrequency ablation (RFA) of pancreatic tissue near the duodenum and portomesenteric vessels (PMV) in a porcine model with and without intraluminal duodenal cooling.
  
  
  BACKGROUND
  RFA has been proposed as a new treatment strategy in patients with unresectable locally advanced pancreatic cancer. RFA may cause thermal damage to the duodenum and vascular structures, but these risks and potential protective measures have never been systematically addressed. Intraluminal duodenal cooling during RFA could prevent thermal damage to the duodenum.
  
  
  METHODS
  RFA was performed in 11 pigs during laparotomy with a bipolar probe of 30 mm active length at a power of 30 W until a total energy of 15 kJ was administered. The RFA probe was inserted in the pancreas at 5 or 15 mm from the duodenum, PMV, and in the pancreatic tail. RFA near the duodenum was performed with and without intraluminal duodenal cooling using 100 mL/min saline of 5°C. Histopathologic assessment was performed.
  
  
  RESULTS
  The maximum RFA-induced temperature was 92°C. RFA with one single probe induced adequate ablation lesions with a diameter of 20 mm over a length of 30 mm. Without duodenal cooling, RFA induced duodenal thermal damage, whereas with duodenal cooling, no damage was observed. RFA at 15 mm from the PMV resulted in minimal superficial focal vascular damage, without thrombosis or hemorrhage.
  
  
  CONCLUSIONS
  RFA provides adequate ablation zones in the pancreas of the porcine. Thermal damage to the duodenum can be prevented by intraluminal duodenal cooling without loss of ablation effectivity.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Samira
authors.initials: S
authors.lastname: Fegrachi
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
authors.forename: John H
authors.initials: JH
authors.lastname: Klaessens
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.forename: Johan A
authors.initials: JA
authors.lastname: Offerhaus
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D003080:Cold Temperature; D017679:Cryotherapy / Q000379:methods; D004386:Duodenum / Q000502:physiology*; D006470:Hemorrhage / Q000517:prevention & control; D008638:Mesenteric Arteries / Q000293:injuries; D023421:Models, Animal; D010179:Pancreas / Q000098:blood supply / Q000601:surgery*; D011168:Portal System / Q000293:injuries; D013552:Swine; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Duodenal cooling; Pancreatic cancer; Radiofrequency ablation (RFA)