Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma - Review

Q: Why is intrahepatic cholangiocarcinoma (iCCA) difficult to treat?

iCCA has poor prognosis with high rates of post-surgical recurrence. Many patients are not surgical candidates due to locally advanced disease, stage at diagnosis, comorbidities, or advanced age.

Q: Which percutaneous ablative techniques are commonly used for iCCA?

Commonly used therapies include radiofrequency and microwave ablation. Other mentioned options include irreversible electroporation, cryoablation, and reversible electroporation (electrochemotherapy), which are encountered less frequently.

Q: What is the purpose of percutaneous ablation in iCCA?

The goal is to provide local cancer treatment and control, including management of tumors with surgical contraindications as well as recurrent or residual tumors. The review also discusses achieving adequate safety margins and ablation zone size to account for infiltrative lesion margins.

Sep 24, 2026

Uploaded by Riley West

Cholangiocarcinoma (CCA) is an invasive malignancy comprising under 1% of all cancers and 10–15% of primary liver cancers. Intrahepatic CCA (iCCA) shows poor survival and high post-surgical recurrence, and many patients are unsuitable for surgery. Growing evidence supports percutaneous ablative techniques for iCCA up to 3 cm with surgical contraindications, as well as for recurrent or residual disease, aiming at local tumor control. Common approaches include radiofrequency and microwave ablation, while irreversible electroporation, cryoablation, and reversible electroporation are less frequent. The review addresses current minimally invasive roles, local control, and survival outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

1. Introduction

medicina Review Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma Georgios Charalampopoulos 1, Roberto Iezzi 2, Maria Tsitskari 3, Argyro Mazioti 1, Olympia Papakonstantinou 1, Alexis Kelekis 1, Nikolaos Kelekis 1 and Dimitrios Filippiadis 1, * Citation: Charalampopoulos, G.; Iezzi, R.; Tsitskari, M.; Mazioti, A.; Papakonstantinou, O.; Kelekis, A.; Kelekis, N.; Filippiadis, D. Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma. Medicina 2023, 59, 1186. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)medicina59071186 Academic Editor: Seung-Gu Yeo Received: 7 May 2023 Revised: 15 June 2023 Accepted: 20 June 2023 Published: 22 June 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; [charalampopoulosg@outlook.com](charalampopoulosg@outlook.com) (G.C.); [argyromazioti@yahoo.gr](argyromazioti@yahoo.gr) (A.M.); sogoﬁ[anol@gmail.com](anol@gmail.com) (O.P.); [akelekis@med.uoa.gr](akelekis@med.uoa.gr) (A.K.); [kelnik@med.uoa.gr](kelnik@med.uoa.gr) (N.K.) 2 Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy; [roberto.iezzi.md@gmail.com](roberto.iezzi.md@gmail.com) 3 Apollonio Private Hospital, 20 Lefkotheou Avenue, 2054 Strovolos, Nicosia, Cyprus; [mariadote@hotmail.com](mariadote@hotmail.com) * Correspondence: dﬁ[lippiadis@yahoo.gr](lippiadis@yahoo.gr); Tel.: +30-2105831832 Abstract: Cholangiocarcinoma (CCA) is an invasive cancer accounting for <1% of all cancers and 10–15% of primary liver cancers. Intrahepatic CCA (iCCA) is associated with poor survival rates and high post-surgical recurrence rates whilst most diagnosed patients are not surgical candidates. Thereis a growing literature suggesting percutaneous ablative techniques for the management of patients with iCCA measuring 􀀔3 cm with contraindications to surgery as well as for recurrent or residual tumors aiming to provide local cancer treatment and control. Most used ablative therapies for iCCA include radiofrequency and microwave ablation with irreversible electroporation, cryoablation and reversible electroporation (electrochemotherapy) being less commonly encountered techniques. Due to the inﬁltrative margins of the lesion, there is a need for larger safety margins and ablation zone; multi-apparatus ablation or other variations of the technique such as balloon-assisted approaches can be utilized aiming to increase size of the zone of necrosis. The present review paper focuses upon the current role of percutaneous ablative techniques for the therapeutic management of iCCA. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of iCCA, including local control and survival rates. Keywords: intrahepatic cholangiocarcinoma; ablation; cancer 1. Introduction Cholangiocarcinoma (CCA) is an aggressive primary malignancy arising from the epithelial cells of the biliary tract and is the second most common primary liver cancer after hepatocellular carcinoma (HCC) [1] . CCA is an invasive cancer and accounts for <1% of all cancers and 10–15% of primary liver cancers and is subclassiﬁed anatomically as intrahepatic (iCCA), arising proximally to the second-order bile ducts, and extrahepatic (ECC), arising from the extrahepatic bile ducts [2,3] . The growth pattern of iCCA can be mass forming, periductal-inﬁltrating

FAQs

Why is intrahepatic cholangiocarcinoma (iCCA) difficult to treat?

iCCA has poor prognosis with high rates of post-surgical recurrence. Many patients are not surgical candidates due to locally advanced disease, stage at diagnosis, comorbidities, or advanced age.

Which percutaneous ablative techniques are commonly used for iCCA?

Commonly used therapies include radiofrequency and microwave ablation. Other mentioned options include irreversible electroporation, cryoablation, and reversible electroporation (electrochemotherapy), which are encountered less frequently.

What is the purpose of percutaneous ablation in iCCA?

The goal is to provide local cancer treatment and control, including management of tumors with surgical contraindications as well as recurrent or residual tumors. The review also discusses achieving adequate safety margins and ablation zone size to account for infiltrative lesion margins.

Sep 24, 2026

Uploaded by Riley West