title: Intraoperative adverse events during irreversible electroporation-a call for caution.
abstract: BACKGROUND
  Irreversible electroporation is increasingly used for treatment of solid tumors, but safety data remain scarce. This study aimed to describe intraoperative adverse events associated with irreversible electroporation in patients undergoing solid tumor ablation.
  
  
  METHODS
  We analyzed demographic and intraoperative data for patients (n = 43) undergoing irreversible electroporation for hepato-pancreato-biliary and retroperitoneal malignancies (2012 to 2015). Adverse events were defined as cardiac, surgical, or equipment-related.
  
  
  RESULTS
  Adverse events (n = 20, 47%) were primarily cardiac (90%, n = 18), including blood pressure elevation (77%, n = 14/18) and arrhythmia (16%, n = 7/43). All but one was managed medically, 1 patient with arrhythmia required termination of ablation. Bleeding and technical problems with the equipment occurred in 1 patient each. Multivariable analysis revealed previous cardiovascular disease and needle placement close to the celiac trunk associated with increased likelihood for cardiac events.
  
  
  CONCLUSIONS
  Intraoperative cardiac adverse events are common during irreversible electroporation but rarely impair completion of the procedure.
authors.affiliation: Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Patryk
authors.initials: P
authors.lastname: Kambakamba
authors.affiliation: Department of Anesthesiology, University Hospital Zurich, Switzerland.
authors.forename: John M
authors.initials: JM
authors.lastname: Bonvini
authors.affiliation: Department of Radiology, Interventional Radiology Center, University Hospital Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Glenck
authors.affiliation: Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Liliana
authors.initials: L
authors.lastname: Castrezana López
authors.affiliation: Department of Radiology, Interventional Radiology Center, University Hospital Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfammatter
authors.affiliation: Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Electronic address: michelle.deoliveira@usz.ch.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: DeOliveira
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002318:Cardiovascular Diseases / Q000150:complications; D002445:Celiac Artery; D004067:Digestive System Neoplasms / Q000601:surgery*; D018274:Electroporation / Q000295:instrumentation; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology; D006973:Hypertension / Q000209:etiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012186:Retroperitoneal Neoplasms / Q000601:surgery*; D012307:Risk Factors
keywords: Ablation; Anesthesia; Complications; Electroporation