Objective:

To evaluate the feasibility, safety, and preliminary oncologic outcomes of intraoperative IRE as an adjunct for margin accentuation in locally advanced iCCA involving critical vascular structures.

Approach:

• Study Design: Retrospective study using a prospectively maintained clinical database.
• Patient Selection: Three patients with initially unresectable, centrally located mass-forming iCCA treated at a single center between 2023 and 2024.
• Procedure: Extended hepatectomy combined with intraoperative IRE applied at the tumor–hepatic vein interface, followed by vascular detachment.

Key Findings:

• All procedures were completed as planned with no intraoperative complications or IRE-related postoperative adverse events.
• Ninety-day mortality was 0%.
• Postoperative imaging confirmed preserved hepatic vein patency in all patients.
• At a median follow-up of 18 months, no local recurrence at the vascular interface was detected.
• One patient developed a solitary intrahepatic recurrence at 17 months, successfully treated with local ablation.

Interpretation:

Intraoperative IRE for margin accentuation appears to be a feasible and safe adjunct to extended hepatectomy in selected patients with locally advanced iCCA involving the hepatic vein.

Limitations:

• Small sample size of only three patients.
• Lack of long-term oncologic outcome data.
• Need for further studies to validate oncologic benefits.

Conclusion:

Intraoperative IRE may expand surgical indications by enabling radical resection in cases otherwise deemed unresectable.