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.
Highlights
Few endoscopic radiofrequency ablation (ERFA) studies with a limited number of patients have been published[12,13,14,15,16,17,18,19,20,21] and only a minority of these reports suggest that ERFA can prolong the survival of patients with biliary strictures caused by pancreatic carcinomas and distal CCCs13,17,20,21
To the best of our knowledge, this report is the first study to demonstrate that ERFA is an efficient and safe tool for the treatment of patients with unresectable Bismuth type III and IV hilar CCCs and significantly prolonged survival time compared to controls receiving standard treatment (342 d vs. 221 d; p = 0.046)
A minority of studies included more than 50 ERFA procedures[12,13,20,21]
Summary
Few ERFA studies with a limited number of patients have been published[12,13,14,15,16,17,18,19,20,21] and only a minority of these reports suggest that ERFA can prolong the survival of patients with biliary strictures caused by pancreatic carcinomas and distal CCCs13,17,20,21. None of these studies included survival analyses of patients with Bismuth type III and IV CCCs despite the rather short life[5,6,7]. - IV° - III° - Distal cholangiocellular carcinoma - Intrahepatic cholangiocellular carcinoma Pancreas carcinoma Gallbladder carcinoma Other malignomas Systemic palliative chemotherapy (%)
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