In the attached photo of a Pancreatic Duct Adenocarcinoma (PDAC) of the head the arrows point to the posterior encasement of the Superior Mesenteric Artery (SMA) and Superior Mesenteric Vein/ Postal Vein (SMV/PV) .
This posterior-most region cannot be treated with any degree of assurance percutaneously because of the probe separation distance will be to great even at maximum voltage without penetrating the blood vessels and raiding the risk of causing major bleeding. With the open technique this same area can be approached from at least 4 different projections that are not available to the interventional radiologists.
The speed for recovery which every patient desires however, should not supersede the importance of providing the best “local” control in a disease that is unforgiving; considering both are done as outpatient procedures and only the Open allows you the full benefit to explore carefully at the same time. There are roles where percutaneous IRE-NANOKNIFE has an important role, but I do not feel treating some areas of the Pancreas are one of them. Common sense dictated that the ability to visualize from every angle and the ability to physically to be able to palpate the area surrounding the tumor (which may look normal on imaging but may have tumor in it if left behind and not treated will obviously result in treatment failure) is very important.
Finally, the ability to position to position probes in an almost 360degree 3D probe placement pattern increases the likelihood of a complete ablation. Through the mechanic of this are somewhat technical in order to make an informed decision you must know the advantages and limitations of each procedure and know what questions to ask your consultant Nanoknife practitioner.