title: Percutaneous ablation of peribiliary tumors with irreversible electroporation.
abstract: OBJECTIVE
  To assess biliary complications after irreversible electroporation (IRE) ablation of hepatic tumors located < 1 cm from major bile ducts.
  
  
  METHODS
  A retrospective review was conducted of all percutaneous IRE ablations of hepatic tumors within 1 cm of the common, left, or right hepatic ducts at a single institution from January 2011 to September 2012. Computed tomography imaging performed before and after treatment was examined for evidence of bile duct dilatation, stricture, or leakage. Serum bilirubin and alkaline phosphatase levels were analyzed for evidence of biliary injury.
  
  
  RESULTS
  There were 22 hepatic metastases in 11 patients with at least one tumor within 1 cm of the common, left, or right hepatic duct that were treated with IRE ablations in 15 sessions. Median tumor size treated was 3.0 cm (mean, 2.8 cm ± 1.2, range, 1.0-4.7 cm). Laboratory values obtained after IRE were considered abnormal after four treatment sessions in three patients (bilirubin, 2.6-17.6 mg/dL; alkaline phosphatase, 130-1,035 U/L); these abnormal values were transient in two sessions. Two patients had prolonged elevation of values, and one required stent placement; both of these conditions appeared to be secondary to tumor progression rather than bile duct injury.
  
  
  CONCLUSIONS
  This clinical experience suggests that IRE may be a treatment option for centrally located liver tumors with margins adjacent to major bile ducts where thermal ablation techniques are contraindicated. Further studies with extended follow-up periods are necessary to establish the safety profile of IRE in this setting.
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065. Electronic address: Mikhail.Silk@gmail.com.
authors.forename: Mikhail T
authors.initials: MT
authors.lastname: Silk
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065; Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wimmer
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Kyungmouk S
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Srimathveeravalli
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Karren T
authors.initials: KT
authors.lastname: Brown
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Kingham
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Durack
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D018450:Disease Progression; D018274:Electroporation; D005260:Female; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: IRE; irreversible electroporation