Endobiliary radiofrequency ablation for distal extrahepatic cholangiocarcinoma: A clinicopathological study

Eui Joo Kim, Dong Hae Chung, Yoon Jae Kim, Yeon Suk Kim, Yeon Ho Park, Keon Kuk Kim, Jae Hee Cho, Eui Joo Kim, Dong Hae Chung, Yoon Jae Kim, Yeon Suk Kim, Yeon Ho Park, Keon Kuk Kim, Jae Hee Cho

Abstract

Background: Most patients with distal extrahepatic cholangiocarcinoma have developed jaundice or cholangitis at the time of initial diagnosis, which can delay surgery. We aim to evaluate the actual EB-RFA ablation volume and validated the clinical feasibility of preoperative endobiliary radiofrequency ablation (EB-RFA) for resectable distal extrahepatic cholangiocarcinoma.

Methods: The medical records of patients who underwent EB-RFA from July 2016 to June 2017 at a single tertiary academic medical center were reviewed. Inclusion criteria were patients with resectable distal extrahepatic cholangiocarcinoma who required preoperative biliary decompression. Clinical outcomes of EB-RFA were reviewed retrospectively and the surgical specimens were reevaluated.

Results: Of the eight patients who required a delayed operation, preoperative EB-RFA was successfully performed without serious complications including peritonitis, hemobilia, or perforation. Although curative resection was attempted in all patients, one patient underwent open and closure due to hepatic metastasis. Seven patients underwent curative surgical resection and the histology revealed that median maximal ablation depth was 4.0 mm (range, 1-6) and median effective ablation length (histological ablation length/fluorosocopic ablation length) was 72.0% (range, 42.1-95.3).

Conclusions: EB-RFA partially ablated human cancer tissue and preoperative EB-RFA might be a safe and feasible in patients with distal extrahepatic cholangiocarcinoma who require a delayed operation. Ablation of the target lesion longer than the estimated length by fluoroscopy may improve the efficacy of EB-RFA.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Endobiliary radiofrequency ablation (EB-RFA).
Fig 1. Endobiliary radiofrequency ablation (EB-RFA).
A. Preprocedural cholangiogram showing distal extrahepatic bile duct stricture. B. EB-RFA with a temperature-controlled EB-RFA catheter at the proximal side of the stricture. C. Tandem overlapping EB-RFA at the distal side of the stricture. D. Endobiliary balloon sweeping removing necrotic tissues after successful EB-RFA.
Fig 2. Histological analysis.
Fig 2. Histological analysis.
A. Microscopic variables for the effective ablation. Measurement of fluoroscopic ablation length was based on the electrode marker and histological ablation length was based on the length of necrosis parallel to the bile duct in consecutive slides. Effective ablation was calculated as histological ablation length over fluoroscopic ablation length as a percentage. Maximum depth of ablation defined as necrosis between the basal lamina of the normal epithelium and the most deeply positioned necrotic inflammation. B. Microscopic image of the bile duct. Dotted line shows the margin of necrotic tissue and black arrow head shows malignant cell infiltration.
Fig 3. Surgical specimen.
Fig 3. Surgical specimen.
A. Intraoperative image of extrahepatic bile duct showing intact pericholedocal area. B. Macroscopic image of the bile duct necrosis showing yellowish color change.

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