Long-term survival for 15 years after percutaneous transhepatic cholangioscopic and X-ray image-guided microwave tissue coagulation (MTC) in a jaundiced man with non-resected bile duct carcinoma

Bile duct carcinoma is one of the most lethal and aggressive malignancies, with the majority of patients harboring unresectable tumors at presentation. The currernt conventional treatment for bile duct carcinoma is either bile duct resection with hepatectomy or pancreatoduodenectomy based on its location, according to the guidelines for diagnosis and treatment of bile duct carcinoma However, hepatectomy and/or PD is a major operation not well tolerated by jaundiced and aged patients in poor general condition with bile duct carcinoma.We previously reported an inoperable jaundiced woman with bile duct carcinoma who underwent cholangioscopic MTC and survived longer than 13 years.Here, we report another jaundiced patient with bile duct carcinoma with survival longer than 15 years after cholangioscopic MTC.Our method (MTC) uses not only coagulation but also mild hyperthermia on the tumor margins as well as on the ductal lumen. Effects other than hyperthermia such as those of microwave dynamic therapy are also currerntly under investigation.For some patients with bile duct carcinoma in poor general condition, with severe jaundice, and probable early stage of progression, cholangioscopic and X-ray image-guided MTC may be an alternative means of non-operative management aiming not only at palliation but also cure.Which treatment should be chosen (surgical or non-surgical) for treatment in aged patients with bile duct carcinoma whose general condition is poor remains an unresolved issue.