The median survival of patients with CCC (peripheral intrahepatic cholangiocarcinoma) is less than 6 months after establishment of the diagnosis and a small proportion of patients undergo operation, with 18-30 months median postoperative survival and frequent recurrences.
A 45-years-old woman with recurrent intrahepatic cholangiocarcinoma is described. Three years after previous right hepatectomy because of CCC, a new nodular lesion (size 5.5 cm) in the remnant liver was established, with elevated CA 19-9 in the serum (586.6 UI/ml). Fine-needle aspiration biopsy (FNAB) revealed CCC. A decision for percutaneous RFA was taken and a session of ultrasound-guided saline-enhanced RFA using general anesthesia was performed.
Computed tomography after RFA established a total necrosis, but Doppler examination showed a few intratumoral spotty signs of neoangiogenesis left. A second session RFA was indicated and implemented. No complications occurred except a minimal postablation-syndrome. The following contrast-enhanced ultrasound and CT demonstrated complete tumor destruction, which was confirmed also by FNAB.
The patient was followed-up for 69 months by means of contrast-enhanced ultrasound, CT and tumor markers. Neither local or distant intrahepatic recurrences, nor extrahepatic metastases were observed.
The case demonstrates the possibilities of percutaneous RFA in the management of postoperative intrahepatic recurrences of CCC and confirms the significance of this method in the complex approach to the liver tumors.