Irreversible electroporation for liver metastases not amenable to conventional treatments, an experience with technical challenges, clinical outcomes, and complications

Irreversible electroporation (IRE) is a non-thermal ablation technique for perivascular liver tumors unsuitable for conventional thermal ablation due to heat-sink effects. This prospective, single-center, single-arm study (2020–2025) evaluated IRE in 14 patients with 16 anatomically challenging liver metastases (median size 20 mm; range 6–50 mm) following multidisciplinary exclusion from resection or thermal ablation. At one month, primary technical success was 94.4%, achieving complete responses in 100% of tumors < 3 cm and 75% for tumors > 3 cm. Median local recurrence-free survival was 9 months, with a 2-year local recurrence rate of 53%. Time to progression was 41 months, and the estimated 2-year overall survival was 67%. Complications occurred in 50% of procedures, mostly minor or moderate (vascular events, biloma, arrhythmia, and one infection), with zero treatment-related deaths. Follow-up imaging demonstrated maintained vessel patency, limited thermal electrode tract changes, and transient vascular spasms resolving within 24 h. IRE provides a feasible, relatively safe rescue approach for high-risk liver metastases, effectively preserving critical structures.