Endoscopic Radiofrequency Ablation Prolongs Survival of Patients with Unresectable Hilar Cholangiocellular Carcinoma - A Case-Control Study

Abstract

The life expectancy of unresectable hilar cholangiocellular carcinomas (CCCs) is very limited and endoscopic radiofrequency ablation (ERFA) of the biliary tract may prolong survival. Our single-center-study retrospectively analysed all CCC cases, in whom ERFAs of the biliary tract were performed between 2012 and 2017 and compared these to historical control cases who received the standard treatment of sole stent application. ERFA was performed in 32 patients with malignant biliary strictures that were mainly caused by Bismuth III and IV hilar CCCs (66%). 14 of these patients received repeated ERFAs, for an overall performance of 54 ERFAs. Stents were applied after examination of all patients (100%). Adverse events occurred in 18.5% of examinations. Case-control analysis revealed that the survival time of cases with unresectable Bismuth type III and IV hilar CCCs (n = 20) treated with combined ERFA and stent application significantly increased compared to controls (n = 22) treated with sole stent application (342 +/− 57 vs. 221 +/− 26 days; p = 0.046). In conclusion, ERFA therapy significantly prolonged survival in patients with unresectable Bismuth type III and IV hilar CCC. As an effective and safe method, ERFA should be considered as a palliative treatment for all these patients.

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

“…Seven observational studies [14,15,19,[22][23][24][25] were of high quality and six [13, 16-18, 20, 27] were judged as moderate quality in Newcastle-Ottawa Scale assessment. In three RCTs: two studies [10,20] could not be assessed bias risk for no mention of experimental methodology, one study [26] was con ned as low risk by the Cochrane tool.…”

“…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.…”

“…A total of 953 patients were included in this meta-analysis, 447 patients were performed RFA combined stent placement compared with 506 controls only given stent placement. Among those studies, eight studies [10,14,16,17,20,[24][25][26] via ERCP (Endoscopic retrograde Cholangiopancreatography), seven studies [13,15,18,19,21,22,27] used percutaneous transhepatic cholangiography (PTC) to implant stent, ERCP and PTC were mixed used in one research [23]. Types of biliary stents were mentioned in 15 of 16 studies.…”

“…Plastic stents were chosen in 2 studies [20,26], both of them were RCTs. Metal and plastic stents were mixed used in 2 studies [16,22]. The details of selected process were presented in Table.1.…”

Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma

“…As mentioned above, experimental data show that the cellular debris following RFA can trigger a systemic antitumor immune reaction [20-22]; hence, it is presumed that there are synergistic effects of chemotherapy and intraductal RFA, which lead to the observed longer survival in the combination group compared to RFA or chemotherapy alone. Against the background that previous studies predominantly included distal or Bismuth type I or II eCCA, the retrospective case-control study by Bokemeyer et al [36] is of particular interest. They compared retrospectively 20 patients with Bismuth type III and IV PHC receiving intraductal RFA + stenting (85% plastic and 15% metal stent) with a matched control group ( n = 22) treated with stent placement only (91% plastic and 9% metal stent), and the combination group showed a significantly longer survival (342 vs. 221 days, p = 0.046).…”