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) ( 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.