Endobiliary Ablation Improves Survival in Patients With Unresectable Perihilar Cholangiocarcinoma Compared to Stenting Alone

Abstract

Background and AimsPalliative ERCP-directed photodynamic therapy (PDT) and radiofrequency ablation (RFA) are available to treat biliary obstruction from perihilar cholangiocarcinoma (pCCA), but data comparing endobiliary ablation with stenting to biliary stenting alone in these patients are lacking. The aims of this study were to compare (1) survival and (2) frequencies of adverse events in patients with unresectable pCCA who underwent endobiliary ablation and stenting vs biliary stenting alone. MethodsRetrospective cohort study that included 59 patients with unresectable pCCA treated with ERCP-directed biliary ablation (RFA and/or PDT) and stenting (n = 30) or biliary stenting alone (n = 29). The main outcome of interest was survival in patients who underwent any form of endobiliary ablation (RFA and/or PDT) and stenting vs biliary stenting alone, as determined by multivariate Cox proportional hazards modeling analysis. ResultsPatients who underwent any form of endobiliary ablation and stenting had improved survival (10.0 months, 95% CI: 8.4-27.5) compared to biliary stenting alone (6.1 months, 95% CI: 4.8-8.8; adjusted hazard ratio 3.2, 95% CI: 1.3-7.6, P = 0.010), without any difference in the frequencies of adverse events. RFA and stenting was shown to improve survival (10.0 months, 95% CI: 8.5-36.8) compared to stenting alone (6.7 months, 95% CI: 5.4-8.8; adjusted hazard ratio 3.5, 95% CI: 1.3-9.3, P = 0.012). ConclusionEndobiliary ablation (with RFA and/or PDT or RFA alone) followed by stenting was associated with significantly improved survival compared to biliary stenting alone in patients with unresectable pCCA, without an increase in adverse events, and should be offered as first-line palliative therapy.