Bilateral versus unilateral radioactive stent insertion for hilar cholangiocarcinoma.

Abstract

Introduction: Radioactive stent insertion (RSI) is widely used for patients with obstructive hilar cholangiocarcinoma (HC) to increase the stent patency and overall survival (OS). However, one controversy of treating HC patients is determining whether to use unilateral or bilateral stenting. General knowledge on unilateral and bilateral RSI efficacy is still lacking. Aim: To evaluate the clinical efficacy and long-term prognoses of unilateral and bilateral RSI in HC patients. Material and methods: Between January 2016 and December 2020, all HC patients who received unilateral and bilateral RSI at our hospital were selected for this study. We compared the treatment efficacy and long-term prognosis of patients undergoing these two procedures. Results: Overall, 65 HC patients received either unilateral (n = 33) or bilateral (n = 32) RSI. There were no significant differences in the technical (both 100%) and functional (97.0% vs. 90.6%, p = 0.584) success rates between the 2 groups. Stent re-obstruction occurred in 6 and 9 patients in the unilateral and bilateral groups, respectively (p = 0.341). Median stent patency was 214 and 233 days in the unilateral and bilateral groups, respectively (p = 0.650). Median OS was 240 and 281 days in the unilateral and bilateral groups, respectively (p = 0.068). Lastly, the total complication rate was significantly lower in the unilateral group, as compared to the bilateral group (12.1% vs. 34.4%, p = 0.033). Conclusions: Unilateral and bilateral RSI provided comparable clinical efficacy and long-term prognoses of HC patients. However, unilateral stenting exhibited a markedly lower complication rate.

Stent insertion for malignant hilar obstruction: a meta-analysis of percutaneous versus endoscopic approaches

“…The prognosis of MHO patients is generally poor, with a 5-year overall survival (OS) rate of less than 10% [3][4][5]. As patients suffering from MHO incidence are often diagnosed when the underlying disease has already reached an advanced stage, they are generally ineligible for surgical resection [6][7][8].…”

“…Palliative care options for MHO patients generally entail biliary stent insertion, which can rapidly alleviate jaundice and provide patients with the opportunity to undergo subsequent antitumour treatment [6][7][8]. Prior meta-analyses have suggested that bilateral stenting can achieve superior clinical success rates to those associated with unilateral stenting when treating MHO patients, while also lowering rates of stent dysfunction [9,10].…”