Does tumor location affect irreversible electroporation outcomes in pancreatic cancer? A head-to-head comparative cohort study.

OBJECTIVE: Irreversible electroporation (IRE) is a promising non-thermal ablative modality for advanced pancreatic cancer (APC). However, whether tumor location influences outcomes remain unclear due to distinct anatomical relationships between the pancreatic head/neck and body/tail. This study compared the safety, efficacy, and survival outcomes of IRE between patients with pancreatic head/neck and body/tail tumors. METHODS: We analyzed a real-world cohort of 63 consecutive patients with advanced pancreatic cancer (comprising primary, post-resection recurrent, and oligometastatic diseases) who underwent percutaneous CT-guided IRE between March 2018 and July 2024. Patients were stratified into the head/neck group (n=39) and the body/tail group (n=24). Baseline characteristics, procedural parameters, adverse events, overall survival (OS), event-free survival (EFS), and tumor marker changes (CA19-9/CEA) were compared. RESULTS: Median age was 66 years (head/neck) versus 61 years (body/tail) (P = 0.468). The body/tail group had significantly higher body weight (median 56 vs. 47 kg, P = 0.021) and BMI (median 20.19 vs. 17.99 kg/m², P = 0.021). No significant differences were observed in IRE procedural parameters. Elevated serum amylase was the most common adverse event (61.5% vs. 58.3%, P = 1.000), and complication rates were comparable. Median OS from surgery was 8.7 versus 9.37 months (P = 0.788), while OS from diagnosis was 22.80 versus 21.32 months (P = 0.948). Median EFS was 6.00 versus 6.25 months (P = 0.357). No significant differences were found in 1-month post-IRE CA19-9 or CEA ratio changes (P = 0.783 and P = 0.295, respectively). CONCLUSIONS: In this cohort of patients with relatively low BMI, percutaneous CT-guided IRE demonstrated comparable safety and efficacy between pancreatic head/neck and body/tail locations. Tumor location alone may not limit IRE feasibility; however, caution is needed when generalizing these findings to Western populations with higher BMI, and larger prospective studies are warranted.