The safety and efficacy of percutaneous intraductal radiofrequency ablation in unresectable malignant biliary obstruction: A single-institution experience

Abstract

BackgroundPatients with unresectable malignant biliary obstruction have limited life expectancy because of limited stent patency and tumor progression. The aim of our study was to retrospectively evaluate the safety and efficacy of combining intraductal RFA with biliary metal stent placement for patients with malignant biliary obstruction.MethodsPatients who received percutaneous intraductal RFA and biliary stent placement for malignant biliary obstruction between 2013 and 2015 were identified. Outcomes were stent patency, technique and clinical success rate, overall survival (OS) and complication rates. Kaplan-Meier and Cox regression analyses were used to examine the association of various factors with stent patency and OS. Complications and laboratory abnormalities were recorded.ResultsFifty patients were treated with percutaneous RFA and stent placement. The rates of technical success and clinical success were 98% and 92%, respectively. The median stent patency was 7.0 (95% confidence interval [CI]: 5.3, 8.7) months and OS was 5.0 (95% CI: 4.0, 6.0) months. On univariable analysis, previously cholangitis was an independent poor prognosis factor for recurrent biliary obstruction. OS was improved in patients who received more than one intervention compared to those who received only one intervention (log-rank P = 0.007), and in those treated without versus those treated with sequential chemotherapy (log-rank P = 0.017). On multivariable analysis, the occurrence of more than one intervention (P = 0.019) had independent prognostic significance for OS.ConclusionPercutaneous RFA and stent placement is a technically safe and feasible therapeutic option for the palliative treatment of malignant biliary obstruction. The long-term efficacy and safety of the procedure is promising, but further study is required via randomized and prospective trials.

Stent placement combined with intraluminal radiofrequency ablation and hepatic arterial infusion chemotherapy for advanced biliary tract cancers with biliary obstruction: a multicentre, retrospective, controlled study

“…The absence of metastatic diseases, a stricture of < 4 cm, and the level of BO in Bismuth types I–II were independent predictors of longer SPT and OS, probably because the ablation extent and heat penetration depth are limited in patients with larger tumour burdens and complicated anatomies. For example, in pCCA cases, intra-RFA may not achieve complete coagulation necrosis in intraluminal masses in the hilar region [ 37 ]. This limitation can be overcome by step-by-step ablation in cases with stenoses longer than 2 cm; however, complete ablation remains impossible.…”

Nonsurgical Approaches to Treat Biliary Tract and Liver Tumors

“…Finally, a stent is placed across the treated area and the scope is withdrawn (31)(32)(33). Use of RFA delivered via the percutaneous approach for distal cholangiocarcinoma and PHC has also been described (34)(35)(36)(37).…”

Acute and Subacute Effects of Irreversible Electroporation on Normal Common Bile Ducts in a Rabbit Model

“…Malignant biliary tumors are uncommon and usually diagnosed following malignant biliary obstruction [1][2][3]. Surgical resection is currently the only potential curative treatment for early recognition and diagnosis.…”