Comparing Survival After Resection, Ablation, and Radiation in Small Intrahepatic Cholangiocarcinoma.



Hepatectomy is the cornerstone of curative-intent treatment for intrahepatic cholangiocarcinoma (ICC). However, in patients unable to be resected, data comparing efficacy of alternatives including thermal ablation and radiation therapy (RT) remain limited. Herein, we compared survival between resection and other liver-directed therapies for small ICC within a national cancer registry.

Patients and methods

Patients with clinical stage I-III ICC < 3 cm diagnosed 2010-2018 who underwent resection, ablation, or RT were identified in the National Cancer Database. Overall survival (OS) was compared using Kaplan-Meier and multivariable Cox proportional hazards methods.


Of 545 patients, 297 (54.5%) underwent resection, 114 (20.9%) ablation, and 134 (24.6%) RT. Median OS was similar between resection and ablation [50.5 months, 95% confidence interval (CI) 37.5-73.9; 39.5 months, 95% CI 28.7-58.4, p = 0.14], both exceeding that of RT (20.9 months, 95% CI 14.1-28.3). RT patients had high rates of stage III disease (10.4% RT vs. 1.8% ablation vs. 11.8% resection, p < 0.001), but the lowest rates of chemotherapy utilization (9.0% RT vs. 15.8% ablation vs. 38.7% resection, p < 0.001). In multivariable analysis, resection and ablation were associated with reduced mortality compared with RT [hazard ratio (HR) 0.44, 95% CI 0.33-0.58 and HR 0.53, 95% CI 0.38-0.75, p < 0.001, respectively].


Resection and ablation were associated with improved survival in patients with ICC < 3 cm compared with RT. Acknowledging confounders, anatomic constraints of ablation, limitations of available data, and need for prospective study, these results favor ablation in small ICC where resection is not feasible.





Published Version (Please cite this version)


Publication Info

Masoud, Sabran J, Kristen E Rhodin, Elishama Kanu, Jiayin Bao, Austin M Eckhoff, Alex J Bartholomew, Thomas C Howell, Berk Aykut, et al. (2023). Comparing Survival After Resection, Ablation, and Radiation in Small Intrahepatic Cholangiocarcinoma. Annals of surgical oncology, 30(11). pp. 6639–6646. 10.1245/s10434-023-13872-y Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Sabran Masoud

House Staff

Kristen Rhodin

House Staff

Alex Bartholomew

House Staff

Clark Howell

House Staff

T. Clark Howell, MD, MSHS, CTHC, is a Duke general surgery resident interested in the math and science of improving healthcare systems and designing systems which form the character of clinicians. He is currently a post-doctoral research fellow within the LTA researching data science applications within healthcare operations and a clinical ethics fellow researching the character formation of surgeons in The Project on the Good Surgeon. He attended Duke Divinity School earning a Certificate in Theology and Healthcare.


Berk Aykut

House Staff

College/University: Ruprecht Karl University of Heidelberg

Medical School: Ruprecht Karl University of Heidelberg


Manisha Palta

Associate Professor of Radiation Oncology

Clinical research in gastrointestinal malignancies, lymphomas and breast malignancies.


Nicholas Befera

Assistant Professor of Radiology

Charles Yoon Kim

Professor of Radiology

Minimally invasive treatments of liver, kidney, and other solid tumors including microwave ablation, cryoablation, embolization, and radioembolization, treatment of benign tumors such as osteoid osteoma and desmoid tumors with cryoablation, endovascular strategies for treatment of complex central venous occlusions, salvage therapy for failing hemodialysis access,  complex enteral feeding access.


Garth S Herbert

Assistant Professor of Surgery

Kevin Naresh Shah

Assistant Professor of Surgery

Daniel Philip Nussbaum

Assistant Professor of Surgery

Dan German Blazer

Professor of Surgery

Sabino Zani

Associate Professor of Surgery

Peter Allen

David C. Sabiston, Jr. Distinguished Professor of Surgery

I am a Surgical Oncologist with clinical and research training in pancreatic and hepatobiliary malignancy.  In 2018, I joined Duke University as the Chief of Surgical Oncology, and the Chief of Surgery in the Duke Cancer Institute.  Previously, I led the clinical and research efforts regarding pancreatic neoplasia within the Department of Surgery at Memorial Sloan Kettering Cancer Center, and served as the Associate Director for Clinical Programs within the David Rubenstein Center for Pancreatic Cancer Research. I also held the Murray F. Brennan endowed Chair in Surgery. 

Over the previous ten years, I have been interested in the progression of pancreatic precursor lesions called intraductal papillary mucinous neoplasms (IPMN).  These cystic precursor lesions of the pancreas present an opportunity for to both study cancer progression, and potentially prevent the development of this lethal malignancy.  My research has focused on biomarker development to identify high-risk IPMN as well as studies evaluating the cause of this disease process.  I have successfully completed phase II and phase III clinical trials in patients with pancreatic cancer and IPMN, and am currently the PI of a first-in-human multi-center randomized chemoprevention trial for pancreatic cancer that is targeting patients with high-risk IPMN.

My laboratory includes both pre and postdoctoral trainees, and they play a critical role in the development of our pancreatic cancer prevention program. 


Michael Evan Lidsky

Associate Professor of Surgery

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