Surgical resection was associated with improved overall survival in patients with intrahepatic cholangiocarcinoma (iCCA) for tumors measuring 3 cm or above in a study conducted in more than 2000 patients. However, there was no difference in terms of survival between patients who had a tumor smaller than 3 cm who were managed with different strategies. 

“Ablation may be an alternative therapeutic strategy for small iCCA, particularly in patients at risk for high surgical morbidity,” the study team wrote in a report published in the Journal of Surgical Oncology.

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To assess outcomes after surgical resection or ablation to treat iCCA, a team of researchers led by Michael E. Lidsky, MD, from the Department of Surgery at Duke University Medical Center in Durham, North Carolina, conducted a retrospective analysis within the US National Cancer Database. 

The team analyzed a total of 2140 patients who were diagnosed with clinical stage 1 to 3 iCCA between 2010 and 2018. Of these, the majority (87.7%) were treated with resection, while 12.3% had ablation. 

The median tumor size of those who underwent resection was 5.5 cm, while the median tumor size of those who had ablation was 3 cm. 

The researchers found that resection was associated with a median overall survival of 41.2 months, greater than ablation at 28 months. 

However, when they conducted a multivariable analysis, they found no significant difference in terms of overall survival between patients who underwent resection versus ablation. 

“However, there was a significant interaction between tumor size and management,” the researchers wrote.

When they analyzed a subgroup of patients with small tumors (less than 3  cm in diameter), the researchers found no difference in terms of overall survival between resection and ablation. However, when the tumor measured 3 cm or bigger, ablation was associated with increased mortality.

The team concluded surgeons “may consider ablation as an alternative to resection” for tumors smaller than 3 cm.


Kanu EN, Rhodin KE, Masoud SJ, et al. Tumor size and survival in intrahepatic cholangiocarcinoma treated with surgical resection or ablation. J Clin Oncol. Published online September 6, 2023. doi:10.1002/jso.27435