Survival Outcomes of Microwave Ablation Compared with Repeat Liver Resection in the Treatment of Recurrent Intrahepatic Cholangiocarcinoma.

Abstract

Background Only a minority of patients with recurrent intrahepatic cholangiocarcinoma (iCCA) are eligible for repeat resection. However, whether they benefit from minimally invasive ablation treatment is unclear. Purpose To compare the survival outcomes in microwave ablation (MWA) and repeat liver resection (rLR) in the treatment of first recurrent iCCA. Materials and Methods In this secondary analysis of a prospective study (Microwave Ablation and Liver Resection for Intrahepatic Cholangiocarcinoma [MALRIC]) from January 2009 to June 2024, participants from 10 hospitals who underwent curative-intent MWA or rLR for recurrent iCCA within Milan-equivalent criteria were identified. One-to-many propensity score matching and overlap weighting were used to balance baseline characteristics. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively. Log-rank test and Cox stratified modeling on matched sets tested survival differences. Results MWA (<i>n</i> = 375) or rLR (<i>n</i> = 119) was performed in 494 participants (mean age, 57.8 years ± 10.7 [SD]; 344 men). Compared with rLR, participants who underwent MWA had similar OS (MWA vs rLR median, 29.8 vs 34.0 months, respectively; hazard ratio [HR], 0.89; 95% CI: 0.68, 1.17; <i>P</i> = .31) and DFS (MWA vs rLR median, 10.7 vs 14.8 months; HR, 0.78; 95% CI: 0.61, 1.00; <i>P</i> = .07). RLR showed improved DFS compared with MWA when the primary tumor was the large duct subtype (HR, 0.51; 95% CI: 0.32, 0.91; <i>P</i> = .03); there were no surgical complications after the initial resection (HR, 0.72; 95% CI: 0.52, 0.98; <i>P</i> = .04), and the DFS was less than 12 months (HR, 0.65; 95% CI: 0.46, 0.92; <i>P</i> = .02). Compared with rLR, participants who underwent MWA had shorter hospitalization (median, 9 vs 14 days; <i>P</i> < .001) and fewer complications above Clavien-Dindo grade II (rLR vs MWA, 31.3% vs 5.5%, respectively; <i>P</i> < .001). Conclusion Compared with rLR, MWA resulted in similar OS and DFS, and better perioperative outcomes. Clinical trial registration no. NCT06462742 © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Georgiades in this issue.