Surgical Tool for Pancreatic Cancer

Background

The incidence of pancreatic cancer has gradually increased over the 20th century and in the early years of this century. Of patients seen, 85-90% have tumors which are considered surgically unresectable at the time of diagnosis. In the absence of metastatic disease that precludes resection, vascular invasion is the main factor which deems a pancreatic tumor unresectable.

Vascular invasion is a relatively frequent discovery in pancreatic cancer, found in 21-64% of patients. A tumoral infiltration of a large trunk (celiac axis, superior mesenteric artery, or hepatic artery) currently constitutes a contraindication to surgery. This is because of the high morbidity and mortality rates associated with arterial resection and reconstruction. The risk of arterial rupture during surgery means patients are frequently left with grossly positive margins which renders radical resection oncologically unsound with regards to patient survival. The degree of tumor encompassment around the artery dictates the surgical outcome. When a patient is diagnosed with locally advanced pancreatic cancer the main factor which dictates their survival is the vascular, and in particular arterial, encompassment. When a patient has tumor arterial involvement, it means that the tumor is unresectable and the patient will be placed in palliative care.

Technology Overview

Baylor College of Medicine presents a device that surgeons can use at the time of surgery to treat patients who have tumors that would be currently deemed ‘borderline unresectable’ or ‘unresectable’ and thus move their prognosis into the ‘resectable’ group. This device may be used in patients with celiac axis or hepatic artery encompassment or where surgical resection of a vein is not seen as possible.

The device will deliver controlled and targeted mild hyperthermia to diseased loci at the time of surgery, via radiofrequency electromagnetic waves or via a thin film-heating element, which is encased in an insulating cylinder. The insulating cylinder, which encases the heating element protects adjacent tissues and therefore limits co-lateral heating damage.

The device can be used as part of a planned surgical procedure or it can be used if additional tumors are discovered once the patient is in the operating theatre, as vascular involvement is commonly discovered only when the operation is already quite advanced.

Benefits

• Expanding the cohort of patients with resectable pancreatic tumors

Applications

Baylor College of Medicine see this device primarily targeting the superior mesenteric vessels as they are the most frequently involved vessels in this cancer, due to their intimate relationship with the head, the uncinate process, and the body of the pancreas. However, this device may be used in patients with celiac axis or hepatic artery encompassment or where surgical resection of a vein is not seen as possible. Additionally, while the research team is currently focusing on pancreatic cancer, this device may a esectable lso be used to treat other cancers where resection is not favorable, such as sarcomas in the limbs where arterial resection would mean amputation.