Liver abscess as a complication of microwave ablation for liver metastatic cholangiocarcinoma after bilioenteric anastomosis

Purpose: To report complications encountered after microwave ablation (MWA) of liver metastatic cholangiocarcinoma who had history of pancreatoduodenectomy or liver resection with bilioenteric anastomosis. Materials and methods: Retrospective study of eight intrahepatic metastatic cholangiocarcinoma lesions treated with MWA (range from 1.5 to 3.6 cm, mean, 3.2 +/- 1.1 cm) in five male patients from February 2008 to August 2009. All five patients underwent surgical resection of the primary neoplasm before MWA and bilioenteric anastomosis, four of them had intrahepatic biliary dilatation pneumatosis. Results: All lesions were completely ablated according to results of contrast-enhanced ultrasound (CEUS) or contrast-enhanced CT/MRI 1 month after MWA. Liver abscess occurred in five ablation zones (5/8 62.5%) of four patients. Fistula encountered in all of the four cases including liver-pleural cavity fistula in two cases, liver-subcutaneous fistula in one case, both liver-pleural cavity and liver-subcutaneous fistula in one case. Two patients had right empyema, and one patient combined with melaena. Tumour cells were isolated from pus in one case. Three cases were satisfactorily cured with antibiotic administration, catheter drainage and supportive treatment; one case died 13 days after MWA. Conclusion: There is a high incidence of abscess formation due to multiple risk factors when MWA was used for treatment of intrahepatic metastatic cholangiocarcinoma with bilioenteric anastomosis. Understanding the causes and grasping disposal methods will help to avoid or successfully cure this major complication.