Multicenter retrospective cohort study of microwave ablation versus liver resection for primary intrahepatic cholangiocarcinoma

Ablation has been recommended as first-line treatment for hepatocellular carcinoma, while evidence regarding its efficacy for primary intrahepatic cholangiocarcinoma (iCCA) is lacking. A cohort study at ten centers in China (2009-2022) compared prognosis of iCCA within Milan criteria after microwave ablation (MWA) versus liver resection (LR). By propensity score matching, 203 patients in the MWA group were matched with 588 patients in the LR group. Compared with LR, MWA demonstrated similar overall survival (5-year 44.8% versus 40.4%; HR 0.96; p=0.761). There was an improvement in 5-years disease-free survival rate for MWA from 17.6% in 2009-2016 to 37.3% in 2017-2022, becoming comparable to the 40.8% of LR (p=0.129). The proportion of ablative margins ≥ 5 mm increased from 25% tot 61% over the two periods, while this proportion of surgical margins was 62% and 77%, respectively. Similar DFS was observed when both ablative and surgical margins exceeded 5 mm (p=0.41). The authors conclude that MWA may be considered as a viable alternative to LR for iCCA within Milan criteria when an adequate margin can be obtained.