Irreversible electroporation for perihilar cholangiocarcinoma (Klatskin tumors)

The overall prognosis for patients with perihilar cholangiocarcinoma (PHC) is dismal. Resection of the tumor remains the only curative treatment, but only 10-20% of patients have resectable disease at the time of diagnosis [1]. The majority of patients present with locally advanced disease or lymph node metastases upon presentation or during exploratory laparotomy which makes resection not amenable. As the prognosis of patients with locally advanced PHC (LAPHC) or PHC with lymph node metastases in the palliative setting is significantly better compared to patients with organ metastases [2], ablative therapies may be of use for symptom palliation and potential survival benefit. Unfortunately, current ablative techniques for LAPHC are limited by serious side effects. These limitations may be overcome by irreversible electroporation (IRE), of which the safety and feasibility have been demonstrated in the presence of main bile ducts and large vascular structures [3-5].