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Irreversible electroporation of renal tumours: A review and an update.

Anthony Kodzo-Grey Venyo*

Background: Irreversible electroporation (IRE) for small localized renal carcinomas is a new treatment option for renal tumours than is being sporadically reported but majority of clinicians are not familiar with the procedure globally. Aim: To review the literature on IRE. Method: Various internet data bases were searched. Results: Irreversible electroporation (IRE) refers to a soft tissue ablation technique which utilizes ultra-short but strong electrical fields to create permanent and thus lethal nanopores within the cell membrane which tends to disrupt the cellular homeostasis. The ensuing cell death emanates from apoptosis and not necrosis as does result in all other types of thermal or radiation-based ablation techniques. The main idea behind the utilization of irreversible electroporation relates to the ablation of tumours within regions where there is importance or need for precision and conservation of the extracellular matrix, blood flow as well as nerves. The technique of irreversible electroporation, UN the form of NanoKnife ablation system, is, basically for the surgical ablation of soft tissue tumours. IRE of kidney tumours can be undertaken under radiological image guidance at open surgery, laparoscopic surgery or as a percutaneous procedure and generally the procedure tends to be associated with short-hospital stay, minimal Clavien Dindo grade 1 complication or higher. Successful renal tumour destruction tends to be high and greater than in 90% of patients and this can be detected by evidence of non-contrast enhancement of the lesion on radiological imaging following the procedure. Residual/recurrent lesions can be further treated by further IRE, radiofrequency ablation, cryotherapy or salvage partial nephrectomy. The short- and intermediate- term oncological outcome associated with IRE for small localized renal carcinomas is good but there are not many long-term follow-ups on patients with small renal tumours treated by IRE. IRE can be used to treat patients with significant comorbidities that would preclude them for partial or radical nephrectomy. A large global multi-centre study of IRE for small localized renal carcinomas would be recommended to ascertain if IRE should be recommended as a gold standard alternative to partial/radical nephrectomy. Conclusion: IRE for small renal carcinomas is an emerging treatment for small renal carcinomas associated with short hospital stay, minimal complications, reasonably good rate of destruction of tumour and good short-and medium term oncological outcome but possible residual tumour can be diagnosed by presence of persistent contrast enhanced renal lesion after the IRE which can be retreated by various techniques including re-IRE.