Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3596–3602 | Cite as

Thermal Ablation Versus Repeated Hepatic Resection for Recurrent Intrahepatic Cholangiocarcinoma

Hepatobiliary Tumors



Repeated hepatic resection (HR) and thermal ablation therapy (TAT) are increasingly being used to treat recurrent intrahepatic cholangiocarcinoma (RICC). This study compared the efficacy and safety of these procedures for RICC treatment.


Patients were studied retrospectively after curative resection of RICCs by repeated HR (n = 32) or TAT (n = 77). Treatment effectiveness and prognosis were compared between the two treatment groups.


The repeated HR and TAT groups did not differ in their overall survival (OS; p = 0.996) or disease-free survival (DFS; p = 0.692) rates. However, among patients with recurrent tumors >3 cm in diameter, patients in the repeated HR group had a higher OS rate than patients in the TAT group (p = 0.037). The number of recurrent tumors and the recurrence interval were significant prognostic factors for OS. The major complications incidence rate was greater in the repeated HR group than in the TAT group (p < 0.001).


Repeated HR and TAT are both effective treatments for RICC with similar overall efficacies. TAT should be preferred in any cases when the RICC is ≤3 cm in diameter and technically feasible. However, for large tumors (>3 cm), repeated HR may be a better choice.


  1. 1.
    Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet. 2005;366:1303–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Malhi H, Gores GJ. Cholangiocarcinoma: modern advances in understanding a deadly old disease. J Hepatol. 2006;45:856–67.PubMedCrossRefGoogle Scholar
  3. 3.
    Chen LP, Li C, Wang C, Wen TF, Yan LN, Li B. Predictive factors of recurrence for patients with intrahepatic cholangiocarcinoma after hepatectomy. Hepatogastroenterology. 2012;59:1765–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248:84–96.PubMedCrossRefGoogle Scholar
  5. 5.
    Shimizu J, Dono K, Nagai K, et al. [A case of intrahepatic recurrence of intrahepatic cholangiocarcinoma treated with repeated hepatectomy]. Gan To Kagaku Ryoho. 2011;38:2469–71.PubMedGoogle Scholar
  6. 6.
    Kurosaki I, Hatakeyama K. Repeated hepatectomy for recurrent intrahepatic cholangiocarcinoma: report of two cases. Eur J Gastroenterol Hepatol. 2005;17:125–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Morise Z, Sugioka A, Hoshimoto S, et al. Patient with advanced intrahepatic cholangiocarcinoma with long-term survival successfully treated with a combination of surgery and chemotherapy. J Hepatobiliary Pancreat Surg. 2008;15:545–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Ohtsuka M, Kimura F, Shimizu H, et al. Significance of repeated resection for recurrent intrahepatic cholangiocarcinoma. Hepatogastroenterology. 2009;56:1–5.PubMedGoogle Scholar
  9. 9.
    Song SC, Heo JS, Choi DW, Choi SH, Kim WS, Kim MJ. Survival benefits of surgical resection in recurrent cholangiocarcinoma. J Korean Surg Soc. 2011;81:187–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Slakey DP. Radiofrequency ablation of recurrent cholangiocarcinoma. Am Surg. 2002;68:395–7.PubMedGoogle Scholar
  11. 11.
    Genov I, Grigorov N, Mitova R, Golemanov B, Dinkov L. [Radiofrequency ablation of recurrent intrahepatic cholangiocarcinoma: a case report]. Khirurgiia (Sofiia). 2005;45–7.Google Scholar
  12. 12.
    Rai R, Manas D, Rose J. Radiofrequency ablation of recurrent cholangiocarcinoma after orthotopic liver transplantation—a case report. World J Gastroenterol. 2005;11:612–3.PubMedGoogle Scholar
  13. 13.
    Oshima S, Takaishi K, Kurokawa E, et al. [A case of successful management of recurrent intrahepatic cholangiocarcinoma by repeated radiofrequency ablations]. Gan To Kagaku Ryoho. 2009;36:2404–6.PubMedGoogle Scholar
  14. 14.
    Kim JH, Won HJ, Shin YM, Kim PN, Lee SG, Hwang S. Radiofrequency ablation for recurrent intrahepatic cholangiocarcinoma after curative resection. Eur J Radiol. 2011;80:e221–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Fu Y, Yang W, Wu W, Yan K, Xing BC, Chen MH. Radiofrequency ablation for postoperative recurrences of intrahepatic cholangiocarcinoma. Chin J Cancer Res. 2011;23:295–300.PubMedCrossRefGoogle Scholar
  16. 16.
    Nakajima Y, Ko S, Kanamura T, et al. Repeat liver resection for hepatocellular carcinoma. J Am Coll Surg. 2001;192:339–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Liang HH, Chen MS, Peng ZW, et al. Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: a retrospective study. Ann Surg Oncol. 2008;15:3484–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Matsuda M, Fujii H, Kono H, Matsumoto Y. Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg. 2001;8:353–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee WS, Yun SH, Chun HK, et al. Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis. J Clin Gastroenterol. 2008;42:945–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Mulier S, Ni Y, Jamart J, Michel L, Marchal G, Ruers T. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol. 2008;15:144–57.PubMedCrossRefGoogle Scholar
  21. 21.
    Kim KH, Yoon YS, Yu CS, et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc. 2011;81:25–34.PubMedCrossRefGoogle Scholar
  22. 22.
    Goldberg SN, Grassi CJ, Cardella JF, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology. 2005;235:728–39.PubMedCrossRefGoogle Scholar
  23. 23.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Taylor-Robinson SD, Toledano MB, Arora S, et al. Increase in mortality rates from intrahepatic cholangiocarcinoma in England and Wales, 1968–1998. Gut. 2001;48:816–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology. 2001;33:1353–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Kamphues C, Seehofer D, Eisele RM, et al. Recurrent intrahepatic cholangiocarcinoma: single-center experience using repeated hepatectomy and radiofrequency ablation. J Hepatobiliary Pancreat Sci. 2010;17:509–15.PubMedCrossRefGoogle Scholar
  27. 27.
    Chiou YY, Hwang JI, Chou YH, Wang HK, Chiang JH, Chang CY. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J Med Sci. 2005;21:304–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Giorgio A, Calisti G, De Stefano G, et al. Radiofrequency ablation for intrahepatic cholangiocarcinoma: retrospective analysis of a single centre experience. Anticancer Res. 2011;31:4575–80.PubMedGoogle Scholar
  29. 29.
    Shen WF, Zhong W, Liu Q, Sui CJ, Huang YQ, Yang JM. Adjuvant transcatheter arterial chemoembolization for intrahepatic cholangiocarcinoma after curative surgery: retrospective control study. World J Surg. 2011;35:2083–91.PubMedCrossRefGoogle Scholar
  30. 30.
    Wu ZF, Zhang HB, Yang N, Zhao WC, Fu Y, Yang GS. Postoperative adjuvant transcatheter arterial chemoembolisation improves survival of intrahepatic cholangiocarcinoma patients with poor prognostic factors: results of a large monocentric series. Eur J Surg Oncol. 2012;38:602–10.PubMedCrossRefGoogle Scholar
  31. 31.
    Yu MA, Liang P, Yu XL, et al. Liver abscess as a complication of microwave ablation for liver metastatic cholangiocarcinoma after bilioenteric anastomosis. Int J Hyperthermia. 2011;27:503–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  1. 1.Minimal Invasion Therapy Department 1Eastern Hepatobiliary Surgery HospitalShanghaiChina
  2. 2.Division of Interventional Ultrasound, Department of Hepatobiliary SurgeryThe First Affiliated Hospital, Sun Yat-Sen UniversityGuangzhouChina

Personalised recommendations