Irreversible Electroporation (NanoKnife) Ablation Makes Clinical Debut in Pancreatic Cancer, Offering a Safer and More Effective Minimally Invasive Treatment Option

Recently, Professor Zheng Jiasheng from the Department of Minimally Invasive Oncology at Peking University International Hospital successfully performed minimally invasive tumor surgeries on two patients with advanced-stage cancer. Of particular note,One patient with pancreatic head cancer underwent the first “NanoKnife ablation” procedure formally applied in clinical practice in Beijing, ushering in a new chapter in minimally invasive treatment for tumors in high-risk locations such as pancreatic cancer.

One month post-operation, the patient has recovered well and is even able to perform daily household chores. In an interview with VCBeat, Professor Zheng Jiasheng revealed that the patient’s recovery was attributed to the clinically effective application of NanoKnife ablation technology. As a leading expert in the Expert Group for the “Administrative Specifications for Tumor Ablation Therapy Technology” issued by the National Health Commission, and as the Chairman of the Ministry of Science and Technology’s Strategic Alliance for Technological Innovation in Minimally Invasive Tumor Therapy Industry, Professor Zheng has dedicated 39 years to the field of minimally invasive tumor treatment. He has performed over 50,000 minimally invasive interventional procedures, including more than 14,000 minimally invasive tumor ablation surgeries. His needle-based minimally invasive closed surgical technique has pioneered a new model of tumor treatment that preserves human anatomical structures and organ physiological functions, achieving disease cure without causing disability. As early as July 2015, he conducted the first clinical trials of NanoKnife ablation surgery in China. Among these cases, one patient with unresectable pancreatic head cancer treated with NanoKnife has remained healthy and tumor-free for over nine years to date.

According to Professor Zheng Jiasheng,Nanoknife ablation therapy is a revolutionary and disruptive innovative technology., which works by releasing high-voltage pulsed currents through precise electrode probes to accurately create countless nanoscale micropores in the tumor cell membrane, directly leading to irreversible electroporation technology that causes structural damage and rapid apoptosis of cells, thereby achieving effective treatment of tumors.

Unlike traditional ablation therapies, it does not rely on physical ablation methods using “heat” or “cold.” Instead, it employs high-voltage pulsed electric fields to directly target tumor cell membranes. This characteristic gives NanoKnife ablation a unique advantage in treating tumors adjacent to critical anatomical structures such as blood vessels, nerves, bile ducts, pancreatic ducts, trachea, intestines, and ureters, providing patients with a safer and more efficient treatment option that is expected to significantly improve overall oncological outcomes and quality of life.

Reviewing the NanoKnife ablation procedure, Professor Zheng Jiasheng told VCBeat that prior to the ablation surgery, the team used contrast-enhanced CT scans to precisely delineate the contours of the lesion, blood vessels, and other critical ductal systems. This allowed for accurate needle placement, whereby high-voltage pulsed electric currents rapidly created nanoscale pores in the tumor cell membranes, leading to rapid apoptosis. After completing the ablation, the team performed another contrast-enhanced CT scan to confirm that the tumor had become a low-density necrotic area and that no damage had been inflicted on surrounding tissues.

However, the success of the surgery was only the first step in the treatment process. Postoperatively, the patient’s serum amylase levels temporarily rose to over 1,900 U/L, posing a significant challenge to her recovery. In response, Professor Zheng Jiasheng’s team implemented measures such as fasting (nil per os) and pharmacological therapy, while closely monitoring the patient’s clinical status. After meticulous management, the patient’s serum amylase levels returned to normal. She gradually resumed oral intake and was successfully discharged one week after the surgery.

In fact, as early as 1985, Professor Zheng Jiasheng began to engage in ablation procedures, undergoing multiple stages of exploration ranging from chemical ablation, radiofrequency ablation, microwave ablation, and cryoablation to nanoknife ablation for the treatment of liver cancer, lung cancer, renal cell carcinoma, prostate cancer, pancreatic cancer, and bone tumors. He is well aware that each ablation technology has its unique advantages and limitations, and the emergence of nanoknife ablation technology has undoubtedly brought new breakthroughs in the treatment of tumors in high-risk locations such as pancreatic cancer. In July 2015, Professor Zheng Jiasheng conducted the first clinical trial in China using the NanoKnife system produced by AngioDynamics (USA).

In addition to pancreatic cancer, irreversible electroporation (IRE) ablation can also provide curative treatment for tumors such as liver cancer, ampullary carcinoma, cholangiocarcinoma, renal cell carcinoma, and prostate cancer. Professor Zheng Jiasheng stated,The advantages of nanoknife ablation technology lie in its minimally invasive nature, precision, efficiency, and safety: it precisely destroys tumor cells while causing minimal damage to blood vessels and nerves.It is particularly suitable for the treatment of early-stage tumors in high-risk areas such as the pancreas and hepatic hilum, and also provides an effective therapeutic option for patients with mid-to-late stage tumors in high-risk locations that are unresectable or deemed unresectable prior to surgery. Furthermore, nanoknife ablation technology represents a viable alternative for elderly or frail cancer patients who are unable to tolerate surgical intervention.

It is worth mentioning that Professor Zheng Jiasheng used a domestically produced NanoKnife device for this surgery. Professor Zheng Jiasheng emphasized:“Domestically produced nanoknife systems are not inferior to imported equipment in terms of performance.”。”

However, an overview of the current landscape reveals that China’s nanoknife industry remains relatively nascent compared to its international counterparts. Meanwhile, pricing is also a significant factor constraining market development. Professor Zheng Jiasheng told VCBeat that, as a high-end medical device, the nanoknife carries a relatively high price tag, with each procedure costing approximately RMB 200,000, which has, to some extent, limited its widespread adoption.

In terms of cost, Beijing has included tumor nanoknife ablation therapy in the Class B reimbursement scope of its medical insurance program, which undoubtedly provides a strong impetus for the widespread adoption of this technology.

In addition to cost concerns, Professor Zheng Jiasheng also frankly admitted that,Standardized operations and homogeneous applications are the main obstacles to current widespread adoption.

In the field of oncology treatment, irreversible electroporation (IRE) ablation is demonstrating its unique advantages. Professor Zheng Jiasheng also points out that the core elements of surgical success lie first in sophisticated operative technique, which requires execution by experts with extensive practical experience. Meanwhile, the procedure must strictly adhere to standardized protocols, including intraoperative contrast-enhanced imaging, three-dimensional reconstruction, and stereotactic localization, to comprehensively assess the relationship between the tumor and major blood vessels as well as vital organs, thereby ensuring precise needle placement and accurate ablation. Immediate postoperative contrast-enhanced scanning to evaluate tumor ablation necrosis and check for severe complications such as hemorrhage is a critical step in ensuring surgical success.

As the head of the expert panel for the National Health Commission’s “Technical Management Specifications for Tumor Ablation Therapy” (2022 Edition) and the chairman of the Ministry of Science and Technology’s Strategic Alliance for Technological Innovation in Minimally Invasive Tumor Treatment Industry, Professor Zheng Jiasheng’s team not only participated in the formulation of these management specifications but also saw the National Alliance for Minimally Invasive Tumor Treatment release national group standards.A comprehensive standard system has been established. Relying on this framework, the Alliance has developed a training system and an independent third-party certification-based quality control and evaluation system, promoting the mature and homogeneous clinical application of this technology through the “One-Ten-Hundred-Thousand-Ten Thousand Project.”

Moreover, with the rapid advancement of imaging equipment technology, preoperative surgical simulation has become feasible. Professor Zheng Jiasheng stated that by leveraging patient imaging data for comprehensive volumetric measurements, ablation volume assessment, virtual reality technology, and robotic needle insertion techniques, detailed simulated rehearsals can be conducted. These simulations, combined with patient-specific image-guided operational modeling, lay a solid foundation for subsequent clinical applications. This represents a key future direction for his team. Furthermore, they have equipped themselves with an advanced robotic navigation system—specifically, a navigated needle insertion system—to further enhance the precision and safety of surgical procedures.

In the development of integrated operating rooms, Professor Zheng Jiasheng has also spared no effort. He is committed to integrating and optimizing all equipment, systems, and processes within the operating room to enhance surgical efficiency and safety.The integrated minimally invasive operating room standards, for which he served as the lead developer, were granted a national patent in 2015 (Patent No. ZL 2015 2 0045514.9). He emphasized that these initiatives will establish a comprehensive framework encompassing advanced diagnostic and therapeutic technologies, standardization systems, training programs, and quality control and evaluation mechanisms, thereby facilitating the standardized and homogeneous delivery of advanced minimally invasive diagnostic and treatment services to patients.