Irreversible electroporation (NanoKnife®) for pancreatic cancer

Irreversible electroporation (IRE) is a treatment that uses 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 and may 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 only have limited information about how well it works. The National Institute for Health and Care Excellence (NICE) says that IRE should only be used in research studies looking at how well it treats pancreatic cancer. This means that some NHS hospitals are collecting information about how it works for pancreatic cancer.

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 it. It may also be available privately.

Who can have IRE?

IRE may be suitable for some people with locally advanced pancreatic cancer. Locally advanced pancreatic cancer is cancer that has spread just outside the pancreas to the large blood vessels near the pancreas, or to a number of lymph nodes. It can’t usually be removed with surgery.

Some hospitals that provide IRE may also offer it to a few people with borderline resectable pancreatic cancer. Borderline resectable pancreatic cancer is cancer that has grown very close to the large blood vessels near the pancreas. Surgery to remove the cancer may be possible, but it depends which blood vessels are affected. For a small number of people, IRE may be used to treat the cells around the edges of the tumour before it is removed.  The aim of IRE for borderline resectable cancer is to make removing the cancer as successful as possible. 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 any more treatment before having IRE.

IRE 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 to treat the cancer. Read more about what happens during IRE.

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.
  • Some people have problems such as feeling and being sick, and heartburn. These side effects don’t usually last long.
  • Some people get inflammation of the pancreas (pancreatitis). They may 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.

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

As there isn’t much research into IRE, if you are thinking about having it it’s really important to speak to your doctor 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. You can find more questions below. 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?
  • Which hospital will I go to for IRE?
  • What does IRE involve?
  • 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?
  • Will I need extra support after having IRE?
  • Will I need further treatment after IRE?

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 this information:

  • Brian Davidson, Consultant HPB and Liver Transplant Surgeon, Royal Free London NHS Foundation Trust
  • Nicola de’ Liguori Carino, Consultant Hepatobiliary and Pancreatic Surgeon, Manchester Royal Infirmary
  • Krish Menon, Consultant Surgeon Liver Transplantation, Hepatobiliary and Pancreatic Surgery, King’s College Hospital, London
  • Tze Min Wah, Consultant Interventional Radiologist, St James’s University Hospital
  • Sanjay Pandanaboyana, Consultant HPB Surgeon, Freeman Hospital, Newcastle Upon Tyne
  • Praveen Peddu, Consultant Radiologist, King’s College Hospital, London
  • Pancreatic Cancer UK Lay Information Reviewers
  • Pancreatic Cancer UK Specialist Nurses

Updated: February 2021

To be reviewed: February 2023