Microwave ablation may offer clinicians a less invasive alternative to repeat liver resection for patients with first recurrent intrahepatic cholangiocarcinoma (iCCA), with comparable survival and improved perioperative outcomes, according to new multicentre data.
Microwave Ablation Compared with Repeat Resection
Only a minority of patients with recurrent iCCA are fit for or eligible to undergo repeat liver resection. As a result, interest has grown in minimally invasive approaches such as microwave ablation. However, robust comparative data have been limited.
The new analysis draws on the prospective MALRIC study, including patients treated between 2009 and 2024 across 10 hospitals. Investigators compared outcomes after curative-intent microwave ablation or repeat liver resection for first recurrence within Milan-equivalent criteria, using propensity score matching and overlap weighting to balance baseline differences.
Overall, 494 patients were included (mean age 57.8 years), with 375 undergoing microwave ablation and 119 repeat resections.
Survival Outcomes: Broadly Comparable
For clinicians weighing oncological efficacy, the key finding was that overall survival did not differ significantly between the two strategies. Median overall survival was 29.8 months with microwave ablation and 34.0 months with repeat resection.
Disease-free survival also appeared similar. Median disease-free survival was 10.7 months after microwave ablation versus 14.8 months following repeat resection. These findings suggest that, in carefully selected patients, local ablative therapy can achieve disease control comparable to repeat surgery.
Subgroups Where Surgery May Still Matter
The analysis did identify scenarios in which repeat resection conferred longer disease-free survival. These included patients with large duct subtype tumours, those without complications after their initial surgery, and those whose first disease-free interval was under 12 months.
While these subgroup findings should be interpreted cautiously, they may help inform multidisciplinary discussions about patient selection and expectations.
Clear Perioperative Advantages for Microwave Ablation
From a real-world clinical perspective, the perioperative benefits of microwave ablation were striking. Hospital stay was significantly shorter (median nine versus 14 days), and major complications were far less common, with Clavien–Dindo grade III or higher events occurring in 5.5% of ablation patients compared with 31.3% after repeat resection.
Implications For Practice
Taken together, the findings support microwave ablation as a viable, lower-morbidity option for selected patients with recurrent iCCA who meet size and number criteria. While not a replacement for surgery in all cases, it expands the therapeutic toolkit for a population with limited options, reinforcing the importance of individualised, multidisciplinary decision-making.
Reference
Pang C et al. Survival outcomes of microwave ablation compared with repeat liver resection in the treatment of recurrent intrahepatic cholangiocarcinoma. Radiology. 2026;318:1.
