Long‐term oncological results of percutaneous radiofrequency ablation for intrahepatic cholangiocarcinoma

Abstract Introduction The effectiveness of percutaneous radiofrequency ablation (RFA) in intrahepatic cholangiocarcinomas (iCCA) remains insufficiently studied. Methods We conducted a retrospective study including patients with histologically proven iCCA within Milan criteria treated by percutaneous RFA from 2000 to 2022. The primary outcome was overall survival in treatment‐naive patients and secondary outcomes included ablation completeness, adverse events, local and distant recurrence. A total of 494 patients with hepatocellular carcinoma (HCC) on cirrhosis treated by RFA were included as a comparison group. Oncological events were analysed using Kaplan–Meier, log‐rank and univariate/multivariate Cox models. Results The main population included 71 patients, mostly cirrhotic (80%) with solitary tumours (66%) of a median size of 24 mm. Local recurrence was 45% at 5 years, lower in multibipolar versus monopolar RFA (22% vs. 55%, p = .007). In treatment‐naive patients ( n = 45), median overall and recurrence‐free survivals were 26 and 11 months, respectively. Tumour size ( p = .01) and Child‐Pugh B ( p = .001) were associated with death. The rate of distant recurrence was 59% at 5 years significantly lower for single tumours of less than 2 ( p = .002) or 3 cm ( p = .02). In cirrhotic patients naïve of previous treatment ( n = 40), overall survival was shorter than in HCC (26 vs 68 months, p < .0001), with more local recurrences ( p < .0001). Among distant recurrences, 50% were extrahepatic metastases compared to 12% in HCC ( p < .001). Conclusion Multibipolar RFA provides better results in terms of tumour recurrence than monopolar RFA and could be used to treat small iCCA (<3 cm). Adjuvant chemotherapy should be discussed due to the frequent extra‐hepatic metastasis at recurrence.