Combining irreversible electroporation with a biliary composite stent implantation in treatment of unresectable hilar cholangiocarcinoma

Abstract

Objective To evaluate the clinical value of combining irreversible electroporation (IRE) with a biliary composite stent implantation in the treatment of unresectable hilar cholangiocarcinoma. Methods A total of sixteen patients with unresectable hilar cholangiocarcinoma were treated in the Fifth Affiliated Hospital of Zhengzhou University, from April 2016 to July 2018 with combined IRE ablation with a 125I particle biliary composite stent implantation. A comparative analysis was conducted on the clinical data including total bilirubin, ALT, AST, myocardial enzymes before and after surgery. Results All patients underwent successful operation and the hemodynamics were stable during the operations. In 16 patients, the myocardial enzymes increased on the first day after surgery and fell to normal within 5 days. A total of thirteen patients had a progressive reduction of CA19-9, 1 patient had no significant change in CA19-9, and 2 patients had CA19-9 in the normal range before and after treatment. Total bilirubin, AST, and ALT decreased gradually after surgery in all the patients. Postoperative complications included biliary bleeding (1 patient), and ascites (1 patient). All patients were able to have the PTCD tube removed after treatment. The median time to PTCD removal was 46 days (range 11~123 days), and the median catheter-free time before requiring another PTCD tube replacement was 184 days (range 43~365 days). Conclusions IRE ablation combined with a biliary composite stent in the treatment of unresectable hilar cholangiocarcinoma was safe. The treatment had good short-term outcomes and it significantly improved the quality of life of the patients. Key words: Klatskin tumor; Bile duct neoplasms; Electroporation; Biliary stent