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Abstract：
Since no uniform treatment protocol for pancreatic irreversible electroporation (IRE) exists, the heterogeneity throughout literature complicates the comparison of results. To reach agreement among experts, a consensus study was performed. Eleven experts, recruited according to predefined criteria regarding previous IRE publications, participated anonymously in three rounds of questionnaires according to a modified Delphi technique. Consensus was defined as having reached ≥80% agreement. Response rates were 100, 64, and 64% in rounds 1 to 3, respectively; consensus was reached in 93%. Pancreatic IRE should be considered for stage III pancreatic cancer and inoperable recurrent disease after previous local treatment. Absolute contraindications are ventricular arrhythmias, implantable stimulation devices, congestive heart failure NYHA class 4, and severe ascites. The inter-electrode distance should be 10 to 20 mm and the exposure length should be 15 mm. After 10 test pulses, 90 treatment pulses of 1,500 V/cm should be delivered continuously, with a 90-µs pulse length. The first postprocedural contrast-enhanced computed tomography should take place 1 month post-IRE, and then every 3 months. This article provides expert recommendations regarding patient selection, procedure, and follow-up for IRE treatment in pancreatic malignancies through a modified Delphi consensus study. Future studies should define the maximum tumor diameter, response evaluation criteria, and the optimal number of preoperative FOLFIRINOX cycles.
摘要：
由于胰腺不可逆电穿孔（IRE）没有统一的治疗方案，整个文献的异质性使结果比较变得复杂。为了在专家之间达成一致，进行了一项共识研究.十一位专家,根据关于以前的IRE出版物的预定义标准招募，根据改进的Delphi技术匿名参加了三轮问卷。共识被定义为达成≥80%的协议。第1至第3轮中的反应率分别为100％、64％和64％；达成共识的比例为93％。对于III期胰腺癌和先前局部治疗后无法手术的复发性疾病，应考虑胰腺IRE。绝对禁忌症是室性心律失常，可植入刺激装置,充血性心力衰竭NYHA4级和严重腹水。电极间距离应为10至20mm,暴露长度应为15mm。10个测试脉冲后，应连续输送90个1,500V/cm的治疗脉冲，脉冲长度为90µs。首次术后对比增强计算机断层扫描应在IRE后1个月进行，然后每三个月。本文提供了有关患者选择的专家建议，procedure,并通过改良的Delphi共识研究对胰腺恶性肿瘤的IRE治疗进行随访。未来的研究应该定义肿瘤的最大直径，反应评估标准，和术前FOLFIRINOX周期的最佳数量。
