Irreversible electroporation (NanoKnife) for pancreatic cancer

Irreversible electroporation (IRE) involves using electrical currents to damage and destroy cancer cells. It is sometimes known as NanoKnife®.

What's in the 'IRE' section?

The aim of IRE is to slow the growth of pancreatic cancer by destroying the cancer cells. This may help some people live longer. It can also help treat symptoms such as pain.

At the moment there has not been much research into IRE for people with pancreatic cancer, so we don’t know enough about how well it works. The National Institute for Health and Care Excellence (NICE) have said that IRE should only be used in research studies looking at how well it treats pancreatic cancer. This means that some NHS hospitals that provide IRE for pancreatic cancer are helping to collect information about how well it works.

IRE is only available in a few hospitals in the UK. If it is suitable for you but isn’t available at your hospital, your doctor may be able to refer you to a hospital that does provide IRE.

Who can have IRE?

IRE may be suitable for some people with locally advanced pancreatic cancer. Locally advanced cancer is cancer that is starting to spread outside the pancreas to nearby organs and blood vessels and can’t be removed with surgery.

In some of the hospitals that provide IRE, it might also be offered to a few people with borderline resectable pancreatic cancer. Borderline resectable cancer is cancer that has grown very close to or around the major blood vessels near the pancreas. It may be possible to have surgery to remove the cancer, but it depends which blood vessels are affected and how far the cancer has grown. For a small number of people, IRE may be used to treat the tumour and try to kill the cancer cells near the blood vessels. The aim of IRE for borderline resectable cancer is to make it possible to remove the cancer, although this will happen for only a few people. There is not much evidence on IRE used in this way, and we need more research into this.

Read more about who IRE may be suitable for.

What does IRE involve?

Before having IRE treatment you will normally have three to six months of chemotherapy on its own or with radiotherapy (chemoradiotherapy). If you have already had chemotherapy or chemoradiotherapy, you may not need to have further treatment before having IRE.

The treatment itself involves having a general anaesthetic so you will be asleep and won’t feel anything. Doctors will insert two to six needles around the tumour. Electrical currents are then passed between the needles.

What are the side effects of IRE?

We need more research into the side effects of IRE for pancreatic cancer.

  • Possible side effects include pain which can be managed with painkillers, and problems with eating and drinking, such as feeling and being sick, and heartburn. These don’t usually last long.
  • Some people get inflammation of the pancreas (pancreatitis), which may mean they need to spend some time in hospital to manage it.
  • A small number of people may get more serious side effects such as a blood clot in a vein – but these are not common.
  • There may be a very small risk of dying after having IRE. This may be caused by damage during the treatment. This is rare.

Read more about the possible side effects. Speak to your doctor about the risks and side effects of IRE.

As there isn’t much research into IRE, if you are thinking about having it it’s really important that you speak to your doctor about it before making any decisions. Ask them any questions you might have about IRE, including whether it is suitable for you, how effective it is, where it’s available, and the possible side effects. Don’t stop any treatment while you are thinking about having IRE.

Questions to ask your doctor or nurse

  • Is IRE an option for me?
  • If it is an option, how can I access it?
  • Will IRE help me to live longer?
  • Will IRE make surgery more likely?
  • Will IRE relieve any of my symptoms?
  • What treatment will I need beforehand?
  • What will happen during the treatment?
  • What side effects am I likely to have?
  • How long will the side effects last and how can they be managed?
  • Which hospital will I go to for the treatment?
  • What is IRE for pancreatic cancer?

Speak to our specialist nurses

You can speak to our specialist nurses on our free Support Line for more information about IRE.

Speak to our nurses
Specialist nurse Nicci

References and acknowledgements


If you would like the references to the sources used to write this information, email us at


We would like to thank the following people who reviewed our information on irreversible electroporation (IRE).

  • Brian Davidson, Consultant Surgeon, Royal Free Hospital and Professor of Surgery, University College London
  • Nicola de’Liguori Carino, Consultant Hepatobiliary and Pancreatic Surgeon, Manchester Royal Infirmary
  • Derek Manas, Professor of Hepatobiliary and Transplant Surgery, Newcastle University
  • Praveen Peddu, Consultant Radiologist and Honorary Senior Lecturer, Kings College Hospital
  • Tze Wah, Consultant Radiologist & Honorary Clinical Associate Professor, St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust
  • Pancreatic Cancer UK Information Volunteers
  • Pancreatic Cancer UK Specialist Nurses

Updated: May 2018

To be reviewed: May 2020