Biliary stenting for unresectable cholangiocarcinoma: A population‐based study of long‐term outcomes and hospital costs in Taiwan

Abstract

Few studies have compared percutaneous biliary stenting (PBS) and endoscopic biliary stenting (EBS) in terms of long-term effects on cholangiocarcinoma (CC), and few have systematically evaluated outcome associations in Taiwan. This study aimed to compare long-term outcomes between two treatments for unresectable CC: PBS and EBS. After propensity score matching (PSM) to reduce the effect of selection bias, 1002 CC patients were included in this analysis: 501 in the PBS group and 501 in the EBS group. The Kaplan-Meier method was used to construct the survival curve for all CC patients, and the Cox proportional hazards model was used for multivariate assessment of outcome predictors. After PSM, group comparisons revealed a significantly longer length of stay in the PBS group compared to the EBS group (25 days vs. 19 days, respectively; p < 0.001). Hospital costs were also significantly higher in the PBS group than in the EBS group (US$126,575 vs. US$89,326, respectively; p < 0.001). The median survival time was 3.7 months in all CC patients, 3.5 months in the PBS group, and 4.0 months in the EBS group. The 1-year, 3-year, and 5-year survival rates were 17.6%, 6.1%, and 3.2% in all CC patients; 16.6%, 4.8%, and 3.2% in the PBS group; and 18.6%, 7.27%, and 3% in the EBS group, respectively. The most important predictor of survival is extrahepatic CC. Medical professionals and healthcare providers should carefully consider the use of EBS for initial treatment of obstructive jaundice in patients with unresectable CC.

Endoscopic radiofrequency ablation combined with fully covered self-expandable metal stent for inoperable periampullary carcinoma in a liver transplant patient

“…The number of living patients with liver transplant has increased over the recent years given improvement in survival and emergence of gastrointestinal tumors has been reported recently. [ 10 , 11 ] We searched PubMed, and Chinese databases Wangfang and CNKI for literature on emergent neoplasms postliver transplant. Between January, 1993, and June, 2012, 47 papers were published on emergent neoplasms postliver transplant.…”

Molecular profiling and treatment pattern differences between intrahepatic and extrahepatic cholangiocarcinoma

“…A study by the Dutch Pancreatic Cancer Group demonstrated that although the use of palliative chemotherapy in patients with distal CCA improved over time, only 32.9% of patients received at least 1 line of palliative chemotherapy by 2016 ( 67 ). The limited use of systemic therapy in patients with ECC may in part be related to 1) worse nutritional and performance status due to patterns of metastasis (ie, high rates of multi-organ and peritoneal metastasis) ( 69-71 ) and 2) local tumor-related complications such as biliary obstruction leading to elevated liver function tests and recurrent cholangitis ( 2 , 5 , 35 , 70 , 72 , 73 ).…”