Electrochemotherapy of cholangiocellular carcinoma at hepatic hilum: A feasibility study

Eur J Surg Oncol. 2018 Oct;44(10):1603-1609. doi: 10.1016/j.ejso.2018.06.025. Epub 2018 Jul 6.


Aim: We evaluated feasibility, safety and efficacy of Electrochemotherapy (ECT) in a prospective series of patients with unresectable Perihilar-Cholangiocarcinoma (PHCCA).

Patients and methods: Five patients with PHCCA underwent ECT. Three patients underwent percutaneous ECT of a single PHCCA nodule. One patient underwent resection of a nodule in the IV segment and intraoperative ECT of a large PHCCA in the VIII segment. Another patient underwent percutaneous ECT of a large PHCCA recurrence after left lobectomy and RF ablation of a synchronous metastasis in the VI segment. ECT was performed under US guidance. Efficacy was evaluated by contrast-enhanced multiple-detector-computed-tomography (MDCT) 4 weeks after treatment. Follow-up entailed MDCT every 6 months thereafter.

Results: No major complication occurred. Follow-up ranges from 10 to 30 months. Four weeks post-treatment CT showed complete response in 3 cases. These patients are still alive, and follow-up CT controls demonstrated no local or distant intrahepatic recurrences and no biliary duct dilation in 2 cases and local recurrence at 18 months follow-up control in 1 patient. In the remaining 2 cases, 4-weeks-post-treatment CT showed incomplete response (>90%). In these patients follow-up CT demonstrated local progression of the disease at 6 months. One of them had bilateral external biliary drainages and died because of tumor progression at 16-months-follow-up. The other patient, died at 10 months follow-up for cardiovascular failure not related to the hepatobiliary disease.

Conclusions: ECT is feasible, safe and effective therapy to improve prognosis and quality of life of patients with unresectable PHCCA.

Keywords: Electrochemotherapy; Percutaneous electrochemotherapy; Perihilar Cholangiocarcinoma.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibiotics, Antineoplastic / administration & dosage
  • Bile Duct Neoplasms / diagnostic imaging
  • Bile Duct Neoplasms / drug therapy*
  • Bile Ducts, Intrahepatic
  • Bleomycin / administration & dosage
  • Cholangiocarcinoma / diagnostic imaging
  • Cholangiocarcinoma / drug therapy*
  • Electrochemotherapy* / adverse effects
  • Electrochemotherapy* / methods
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Multidetector Computed Tomography
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasms, Multiple Primary / diagnostic imaging
  • Neoplasms, Multiple Primary / drug therapy*
  • Neoplasms, Multiple Primary / surgery
  • Prospective Studies
  • Treatment Outcome
  • Ultrasonography, Interventional


  • Antibiotics, Antineoplastic
  • Bleomycin