The safety of electrolytically induced hepatic necrosis in a pig model

Background: Electrolysis fulfils the criteria for an ideal treatment of pat ients with unresectable liver rumours. Previous studies in the rat and pig have shown that controlled necrosis can be safely produced by inserting pla tinum electrodes into normal liver parenchyma and liver tumours. As with an y new treatment it is mandatory to investigate the 'worst-case scenario' of inadvertent intravascular electrode placement in a large animal model befo re progressing to clinical trials. Methods: Under ultrasound control in six pigs, electrodes were inserted int o, or immediately adjacent to, an hepatic vein. An electrolytic 'dose' of 1 00 C was then administered and the evolution of the lesion was monitored us ing ultrasound. Venous blood was collected before and during the electrolys is to evaluate potential acid/base disturbances and animals were closely mo nitored during electrolysis and during their recovery until a full autopsy was performed 4-7 days after treatment. Results: Gas bubbles were seen to enter the hepatic veins or inferior vena cava during treatment in five of the six animals. There were no major compl ications as a consequence and all animals recovered and remained in a healt hy state until they were killed, At autopsy one animal had complete thrombo tic occlusion of the left hepatic vein. Otherwise, findings were normal. Conclusion: In the clinical setting, due to the use of ultrasound to guide electrode placement into the centre of a tumour, the electrodes should rare ly juxtapose an hepatic vein. Nevertheless, in this extreme situation, elec trolysis is surprisingly safe with only one major vascular occlusion and no morbidity or mortality.