Endobiliary radiofrequency ablation for distal extrahepatic cholangiocarcinoma: A clinicopathological study

Abstract

BackgroundMost 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.MethodsThe 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.ResultsOf 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).ConclusionsEB-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.

Usefulness of intraductal RFA in patients with malignant biliary obstruction

“…The actual ID-RFA ablation depth in the human bile duct is approximately 4 mm (1.7–4.3 mm), and the effective length of bile duct ablation has been estimated to be 40% to 72% of the length of the RFA catheter. [ 11 – 13 ] A previous in vivo swine study showed that hilar ID-RFA related perforation in the normal bile duct occurred when a duration of over 90 seconds was used. [ 7 ] However, some clinical studies of hilar ID-RFA revealed no perforation at a duration up to 120 seconds.…”

“…[ 7 ] However, some clinical studies of hilar ID-RFA revealed no perforation at a duration up to 120 seconds. [ 9 , 11 ] Since a cancerous bile duct has a thicker wall than a normal bile duct, we chose to perform hilar ID-RFA for a duration up to 2 minutes to get better outcomes. We chose shorter ID-RFA catheters because longer catheters are not suitable for intraductal ablation, since the perihilar bile duct is angulated and separated, and longer catheters have the potential to cause bilo-vascular complications.…”

Intraductal temperature-controlled radiofrequency ablation in malignant hilar obstruction: a preliminary study in animals and initial human experience

“…1 ; Table 1 ). We tested ID-RFA from currently validated ID-RFA settings in extrahepatic bile ducts from maximally invasive settings (22-mm probe, 10 W, 80 °C, 120 sec) to less invasive settings (11-mm probe, 7 W, 80 °C, 60 sec) 17 19 . After initial assessment to rule out immediate ID-RFA-related AEs, the procedure was completed without biliary stent insertion.…”

Recent developments in endoscopic ultrasound-guided radiofrequency ablation for pancreatic lesions

“…In pancreatobiliary disease, endoscopic retrograde cholangiopancreatography (ERCP)-guided intraductal RFA has also been increasingly performed in malignant biliary tract obstruction. [2][3][4][5] However, the RFA for the pancreas is under investigation due to the increased risk of adverse events. Because the pancreas is a thermosensitive organ with more complex vascular systems, pancreatic neoplasms could infiltrate the bile duct or the duodenal wall, encase major vessels, or occlude the main pancreatic duct (MPD) by proximity.…”