Metal Stenting with or without Endobiliary Radiofrequency Ablation for Unresectable Extrahepatic Cholangiocarcinoma

Abstract

Background: Retrospective comparison of stent patency and survival of patients with unresectable extrahepatic cholangiocarcinoma (CCA) treated by placement of self-expanding metal stents (SEMS) with or without endobiliary radiofrequency ablation (ERFA). Methods: Between January 2010 and September 2014, 76 patients with biliary obstruction caused by unresectable extrahepatic CCA (27 patients with Bismuth type I hilar CCA and 49 patients with distal CCA) were recruited into this study. Patients either received ERFA with SEMS (n = 34) or SEMS only (n = 42). Stent patency and survival of both groups were compared and predictors for overall survival were analyzed. Results: Demographic data were not different between the two groups. Complication rates of both groups were similar. Thirty-day stent patency was obtained in all patients and the median stent patency in the ERFA + SEMS group (9.5 months, 4.5 -14.0 months) was significantly longer than that in the SEMS group (8.4 months, 4.9 -11 months) (P = 0.024). The overall survival curve in the ERFA + SEMS group was significantly better than that of the SEMS group (P = 0.036). Multivariate Cox proportional hazards regression analyses showed that ERFA, tumor AJCC stage, extrahepatic CCA type, serum albumin and adjuvant chemotherapy were significant prognostic factors for overall patient survival. Conclusions: ERFA is effective for unresectable extrahepatic CCA and may improve metal stent patency and patient survival for unresectable extrahepatic CCA with biliary obstruction. Prospective randomized trials will be needed to confirm these findings.

Radiofrequency Ablation Combined with Stent Placement versus Stent Placement Alone for Malignant Biliary Obstruction: A Systematic Review and Meta-analysis

“…Full texts of 376 unique studies were evaluated and assessed for eligibility. Ultimately sixteen articles [10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] were selected for our meta-analysis, including thirteen observational studies [13-19, 21-25, 27] and three RCTs(Randomized Controlled Trials) studies [10,20,26]. The search strategy is presented in Figure.1.…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…The feasibility of EUS‐RFA in the treatment of pancreatic lesions has been demonstrated in small case series, including patients with cystic neoplasms and neuroendocrine tumors . In malignant biliary obstruction, RFA can improve the patency of SEMS and patient survival rates . In a systematic review of nine studies and 505 patients, mean difference in stent patency was 50.6 days (95% CI = 32.8–68.5) with improved survival (hazard ratio 1.39, 95% CI = 1.1–1.7) in favor of RFA + SEMS versus SEMS alone .…”

“…In a systematic review of nine studies and 505 patients, mean difference in stent patency was 50.6 days (95% CI = 32.8–68.5) with improved survival (hazard ratio 1.39, 95% CI = 1.1–1.7) in favor of RFA + SEMS versus SEMS alone . Adverse events with biliary RFA include abdominal pain (31%), cholangitis, hemobilia, cholecystitis (that can also occur in SEMS alone) and partial liver infarction as a result of vascular injury . In a randomized trial of 26 patients with pancreatic cancer, EUS‐RFA has recently been compared to traditional celiac‐plexus neurolysis showing more pain relief, improved quality of life and comparable adverse events .…”

“…101 In malignant biliary obstruction, RFA can improve the patency of SEMS and patient survival rates. [102][103][104][105][106][107][108][109][110] In a systematic review of nine studies and 505 patients, mean difference in stent patency was 50.6 days (95% CI = 32.8-68.5) with improved survival (hazard ratio 1.39, 95% CI = 1.1-1.7) in favor of RFA + SEMS versus SEMS alone. 109 Adverse events with biliary RFA include abdominal pain (31%), cholangitis, hemobilia, cholecystitis (that can also occur in SEMS alone) and partial liver infarction as a result of vascular injury.…”

“…109 Adverse events with biliary RFA include abdominal pain (31%), cholangitis, hemobilia, cholecystitis (that can also occur in SEMS alone) and partial liver infarction as a result of vascular injury. [103][104][105][106][107][108][109][110] In a randomized trial of 26 patients with pancreatic cancer, EUS-RFA has recently been compared to traditional celiacplexus neurolysis showing more pain relief, improved quality of life and comparable adverse events. 111 Photodynamic therapy is another palliative modality for cholangiocarcinoma.…”