Method and efficacy of cryoablation combined with hyperthermia for the treatment of unresectable pancreatic cancer

Abstract Objective: To explore the method and short-term efficacy of cryoablation combined with hyperthermia (CCH) for patients with unresectable pancreatic cancer. Methods: The study recruited 22 patients with unresectable pancreatic cancer diagnosed by a multidisciplinary team (MDT) at the Liaoning Cancer Hospital from February 2023 to December 2023. We explored the treatment procedure and evaluated the efficacy of the CCH therapy. The method of examination and characteristics before and after surgery were compared, and the effectiveness of open surgery versus a laparoscopic approach was evaluated. Results: All patients underwent an MDT-centered surgery to receive CCH. Patients were categorized based on the surgery into simple CCH (n=12, 55%), CCH with bilioenterostomy (n=4, 18%), and CCH with bilioenterostomy and gastroenterostomy (n=6, 27%). The average intraoperative blood loss volume was 114.1±81.1 mL; the average number of cryoprobes used was 1.3±0.5. The average time was 11.6±2.9 min for the first CCH cycle and 12.5±5.3 min for the second cycle. The average postoperative fasting time was 3.1±0.6 days, and the average postoperative hospital stay was 9.2±2.4 days. The rate of postoperative pancreatic fistula was 9.1% (n=2), with severe complications. Pathology of the puncture biopsy tumor tissue showed malignancy in 77.3% of cases. There were no significant differences in tumor markers and CT values before and after surgery. The average maximum diameter of the tumor before and after surgery was statistically significant (P=0.001), but there was no difference in tumor volume change (P=0.67). The surgical approaches included open surgery (n=15, 68%) and laparoscopy (n=7, 32%), with only a difference in surgical categories (P=0.006). Five patients (29%) underwent genetic testing, and all had identified potentially clinically significant mutations, but none had BRCA1/2 germline mutations. Conclusions: CCH therapy through MDT is suggested as the primary treatment approach for unresectable pancreatic cancer. This approach is applied with the aim to demonstrate high safety and low complication rate associated with CCH treatment for unresectable pancreatic cancer.