title: Irreversible electroporation of the liver: is there a safe limit to the ablation volume?
abstract: Irreversible electroporation is a fast-growing liver ablation technique. Although safety has been well documented in small ablations, our aim is to assess its safety and feasibility when a large portion of liver is ablated. Eighty-seven mice were subjected to high voltage pulses directly delivered across parallel plate electrodes comprising around 40% of mouse liver. One group consisted in 55 athymic-nude, in which a tumor from the KM12C cell line was grown and the other thirty-two C57-Bl6 non-tumoral mice. Both groups were subsequently divided into subsets according to the delivered field strength (1000 V/cm, 2000 V/cm) and whether or not they received anti-hyperkalemia therapy. Early mortality (less than 24 hours post-IRE) in the 2000 V/cm group was observed and revealed considerably higher mean potassium levels. In contrast, the animals subjected to a 2000 V/cm field treated with the anti-hyperkalemia therapy had higher survival rates (OR = 0.1, 95%CI = 0.02-0.32, p < 0.001). Early mortality also depended on the electric field magnitude of the IRE protocol, as mice given 1000 V/cm survived longer than those given 2000 V/cm (OR = 4.7, 95%CI = 1.8-11.8, p = 0.001). Our findings suggest that ionic disturbances, mainly due to potassium alterations, should be warned and envisioned when large volume ablations are performed by IRE.
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Sánchez-Velázquez
authors.affiliation: Department of Information and Communication Technologies, Universitat Pompeu Fabra, Carrer Roc Boronat 138, 08018, Barcelona, Spain.
authors.forename: Q
authors.initials: Q
authors.lastname: Castellví
authors.affiliation: Translational Research Laboratory, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av. de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Villanueva
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Quesada
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pañella
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cáceres
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Dorcaratto
authors.affiliation: Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Autonomous University of Barcelona (U.A.B), Plaza Cívica, s/n, 08193 Bellaterra, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Andaluz
authors.affiliation: Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Autonomous University of Barcelona (U.A.B), Plaza Cívica, s/n, 08193 Bellaterra, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Moll
authors.affiliation: Electronic Engineering Department, Universitat Politècnica de Valencia, Camino de Vera, 46022 Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Trujillo
authors.affiliation: Department of Electric Engineering and Communications, University of Zaragoza, Pedro Cerbuna, 12, 50018 Zaragoza, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Burdío
authors.affiliation: Electronic Engineering Department, Universitat Politècnica de Valencia, Camino de Vera, 46022 Valencia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Berjano
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Grande
authors.affiliation: Department of Information and Communication Technologies, Universitat Pompeu Fabra, Carrer Roc Boronat 138, 08018, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ivorra
authors.affiliation: Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Burdío
mesh_terms: D000420:Albuterol / Q000627:therapeutic use; D000818:Animals; D002463:Cell Membrane Permeability; D053672:Electrochemotherapy / Q000009:adverse effects / Q000379:methods*; D005665:Furosemide / Q000627:therapeutic use; D006947:Hyperkalemia / Q000209:etiology* / Q000517:prevention & control; D008099:Liver / Q000473:pathology; D008114:Liver Neoplasms, Experimental / Q000628:therapy*; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D008819:Mice, Nude; D009929:Organ Size; D012372:ROC Curve; D017693:Sodium Bicarbonate / Q000627:therapeutic use
chemical_list: D005665:Furosemide; D017693:Sodium Bicarbonate; D000420:Albuterol