Most pancreatic cancer patients are already in the middle to late stage when they are detected. If the cancer is detected at an early stage, it can be treated by surgery, but for those with advanced stage and distant metastasis, what is the way out? Do we have to sit and wait for death? Physical ablation for locally advanced pancreatic cancer What is locally advanced pancreatic cancer? It is defined as locally advanced pancreatic cancer when the celiac artery or superior mesenteric artery or both are surrounded by the tumor, accounting for 30%-35% at the time of diagnosis. If radiotherapy or chemotherapy is administered, its efficacy is limited, and physical ablation therapy has some effect. However, due to the special organ of the pancreas, the existing ablation methods have a high complication rate and mortality. Foreign reports show that the complication rate of radiofrequency ablation is 28%-40% and the mortality rate is 7.5%. Moreover, physical ablation treatment of pancreatic cancer faces three major problems: incomplete ablation of tumor, damage to blood vessels, and damage to intestinal wall and pancreatic duct. So can the new technology of Nano knife break the bottleneck of ablation treatment? Nano knife is a new cutting-edge tumor ablation technology, which forms nano-scale permanent perforations on tumor cells by releasing high-voltage pulses, disrupting the intracellular balance and causing rapid apoptosis of cells. Nano Knife was approved for clinical application by the US FDA in October 2011, and also passed the CE certification of the European Union. By the end of 2012, more than one hundred core oncology hospitals worldwide have adopted Nano Knife technology. The principle of Nano Knife Nano Knife releases high voltage pulses to tumor cells through a probe, causing irreversible electroporation of their cell membranes at the nanometer level, which leads to apoptosis of cells. After the apoptosis of tumor cells, the phagocytes in the body engulf the cell fragments and the treated area is gradually replaced by normal tissues. Advantages of Nano Knife Clinical research shows that Nano Knife is a safe and efficient tumor treatment technology, and it has the following advantages compared with other tumor treatment technologies: 1. Short ablation time When treating solid tumors of about 3cm in diameter, Nano Knife generally requires only 90 ultra-short pulses of 100 ms. One set of treatment time is less than one minute. Therefore, even if there are three or four ablation areas overlapping each other, the ablation time of the whole process will not exceed 5 minutes. After the treatment, if you are in good health, you can be discharged on the same day or the next day. 2. The important tissues such as blood vessels and nerves in the treated area are preserved. Another feature of Nano Knife ablation technology is that it can protect the important tissue structures in the ablation area. In all the liver tissues treated by Nano Knife, the important structures such as hepatic artery, hepatic vein, portal vein and intrahepatic bile duct can be well protected. In contrast, traditional ablation methods denature proteins by warming or cooling, and all kinds of proteins and DNA are destroyed, and the above structures are damaged beyond repair. 3. The traditional thermal ablation or cold ablation, once there are large blood vessels in the ablation area, the heat will be taken away by the blood flow, resulting in incomplete ablation of the periphery and easy to cause recurrence, while the Nano knife well avoids this problem. 4. Complete treatment and clear treatment boundary Another advantage of Nano knife is that it can ablate the tumor completely regardless of the location, size and shape of the tumor. As mentioned above, IRE can completely ablate tumors, regardless of whether they are close to blood vessels, irregular in shape or large. In addition, the ablation zone of the nanoblade is well defined, with a thickness of only 1-2 cell units. The therapeutic and non-therapeutic zones are clearly distinguished, thus allowing for more accurate judgment and assessment of the effectiveness of the NanoKnife, treatment outcomes, and follow-up. In contrast, other ablation methods such as radiofrequency or microwave will have a “gray area” at the edge of the ablation zone, i.e., there are still a large area of inactivated tumor cells on the outermost area of the ablation zone. This is one of the main hidden dangers that cause tumor recurrence in the future, but Nano knife does not have this problem. 5. The treatment area can be restored to normal function Traditional ablation mode is to make the tissue undergo protein denaturation through temperature, followed by coagulative necrosis, after which the tissue structure in the whole ablation area will no longer exist. The necrotic tissue, which is toxic to the organs, is then left and cannot be restored to normal function. On the contrary, nanoblade induces apoptosis in tumor cells. One of the advantages of apoptosis is that it can use immunity to promote cell death. The human body will recognize apoptosis as a normal cell death process, and then remove the apoptotic tissue through cell phagocytosis to promote the regeneration and repair of normal tissue. 6. The effect process can be monitored in real time Nanosurgery treatment can be navigated and monitored by ultrasound, CT and MR images. With the assistance of imaging equipment, the positioning of the nanosaber probe, the ablation process of the target area and the size of the final ablation zone can be monitored in real time, and the accuracy of the ablation zone boundary in the image can be comparable to the histological accuracy. The size of the ablation zone monitored by ultrasound or CT deviates by only a few millimeters from the true ablation zone measured in the pathological analysis. This demonstrates the high accuracy of image monitoring of nanosaber ablation. The images also clearly show the residual cancer cells that have not been ablated, allowing the physician to ablate them again. In addition, the real-time monitoring also allows the doctor to observe the changes in the surrounding tissues of the ablation area, so as to deduce the possibility of complications and to ensure the safety of the patient as well as to help him/her recover quickly after the operation. 7. Nano knife can adapt to more complex conditions In traditional ablation treatment, once the tumor is near the large blood vessels, near the bile duct, pancreatic duct, hepatic portal vein and other dangerous areas, the treatment cannot be carried out; in addition, for prostate tumors or tumors near the spine, ablation may easily lead to nerve damage and paralysis and loss of sexual function. Since Nano Knife does not damage the ducts and nerves, it is a safe and effective treatment for all the above cases, and has an irreplaceable role for such patients. Nano knife is suitable for liver, lung, kidney, pancreas, prostate and other solid tumors, especially for tumors near the hilar region, gallbladder and bile duct, pancreas and ureter, which have unique advantages. The application of this technology has not been carried out in China yet, and it needs to accumulate experience and further exploration, but its introduction has also brought a new means and hope to patients.