The patient is a 63-year-old woman living in Dalian. Since her diagnosis of pancreatic cancer, she has received multiple lines of therapy, including radiotherapy and chemotherapy; for biliary obstruction, she underwent biliary stent placement and percutaneous transhepatic cholangiography and drainage (PTCD) for jaundice reduction; she also received interventional therapy for secondary malignant neoplasm of the liver. At present, the patient’s clinical stage is T3NxM1 (stage IV), with ascites. Physical examination revealed mild tenderness in the middle and upper abdomen, with no other obvious positive signs. After learning of the profound expertise of Professor Liao Zhengyin of West China Hospital of Sichuan University in the field of minimally invasive tumor ablation, the patient and her family traveled nearly 3,000 km from Dalian to Chengdu to seek treatment.

After multiple lines of therapy, the patient still had problems such as dependence on biliary drainage and a relatively heavy local tumor burden, and there was limited room to further intensify systemic therapy. Following a comprehensive assessment by Professor Liao’s team, it was decided to adopt a palliative local ablation strategy, so as to control the local lesion and reduce the tumor burden while creating conditions for subsequent systemic therapy.

The pancreas is located deep and adjacent to complex structures, with important tissues such as the gastrointestinal tract, bile ducts, portal vein, and superior mesenteric vessels distributed around it; clinically it is regarded as an “organ minefield” for ablation therapy. This procedure was performed under CT guidance with local anesthesia plus sedation, with no muscle relaxant used and no endotracheal intubation throughout. Professor Liao used only one bipolar ablation needle with integrated positive and negative poles, precisely puncturing percutaneously into the pancreatic lesion; while simplifying the puncture path, the single-needle route maximally avoided the stomach, intestines, and major blood vessels.

Thanks to Wknife’s wide-spectrum synergistic technology, the patient received no muscle relaxant injection throughout the procedure, showed no obvious muscle contraction during surgery, was able to respond normally, and had stable vital signs; after the ablation was completed, the team placed a drainage tube for the patient in the same session to reduce the risk associated with postoperative exudation. The entire procedure took less than 1 hour, the patient returned safely to the ward after surgery, and was able to get out of bed and move around 4 hours later.

Intraoperative CT Imaging

This procedure was palliative in nature, aiming to achieve local lesion control and reduce the tumor burden with minimal trauma, and, by debulking the tumor through Wknife ablation, to improve the intratumoral environment, activate immunity, and win conditions for subsequent systemic therapy.

Four hours after the procedure, the patient was already able to get out of bed and move around (the patient’s face has been de-identified for privacy).

Professor Liao Zhengyin said: “This pancreatic site is surrounded by organs and adjacent to important structures such as the gastrointestinal tract and blood vessels. Traditional NanoKnife ablation requires parallel placement of multiple needles, which means many puncture paths and great difficulty in needle placement, and also increases potential risks. Wknife uses a bipolar single-needle design, so a single needle can complete the ablation, making the puncture path clearer, the operation more simplified, and the risk more controllable. For palliative treatment scenarios of advanced pancreatic cancer, this technical approach is particularly clinically valuable.”

Pancreatic cancer is known as the “king of cancers” because of its high degree of malignancy and insidious early symptoms. According to GLOBOCAN 2022 data, China has about 119,000 new cases and about 106,000 deaths each year. The overall 5-year survival rate of pancreatic cancer is less than 10%; due to its insidious onset, about 80% of patients have already lost the opportunity for curative surgery at the time of diagnosis, and the median survival of advanced patients is only 6 to 9 months.

Schematic diagram of the anatomical location of pancreatic cancer: the pancreatic head is encircled by the duodenum, with important vasculature running through layer by layer around it

Local treatment of pancreatic cancer — the difficulty lies precisely in “location”. The pancreas lies deep in the retroperitoneum; the pancreatic head is encircled by the duodenum, and important structures such as the common bile duct, portal vein, and superior mesenteric artery and vein are densely distributed around it. As the tumor progresses, it often becomes closely adjacent to or even invades the surrounding blood vessels, bile ducts, and intestines, making surgical resection and local treatment extremely challenging.

The value of irreversible electroporation (IRE) emerges here: it creates irreversible damage to the cell membrane through a high-voltage pulsed electric field, thereby inactivating tumor cells; by virtue of the tissue selectivity of its non-thermal ablation, it protects the adjacent blood vessels, bile ducts, and intestines to the greatest extent while ablating the tumor, significantly reducing the risk of damage to surrounding organs caused by the special location of the tumor. The Chinese Expert Consensus on NanoKnife Therapy for Pancreatic Cancer has already listed it as an important local treatment modality for unresectable pancreatic cancer.