S0008 Palliative Endoscopic Biliary Radiofrequency Ablation Compared to Percutaneous Biliary Radiofrequency Ablation: A Meta-Analysis on Survival Outcomes

Abstract

INTRODUCTION: Cholangiocarcinoma (CCA) is a malignant gastrointestinal tumor associated with very poor survival outcomes. 5-year survival rates have been reported as low as 2–5% with a median survival of 3–6 months for patient with unresectable disease. Apart from chemotherapy, palliation relies heavily on intraductal stenting, which provides little survival advantage. Endoscopic (ERFA) and percutaneous radiofrequency ablation (PRFA) deliver thermal energy at the tumor site resulting in a coagulative necrosis and cellular death. The study aims to compare survival outcomes in patients undergoing ERFA with those undergoing PRFA for palliation of unresectable CCA. METHODS: A literature review was conducted using the PubMed database for published manuscripts and abstracts comparing survival data in patients undergoing ERFA and PRFA for unresectable CCA. Studies analyzing post-surgical lesions, recurrent lesions, or non-CCA specific survival were excluded from our analysis. Pooled survival data was used to generate a Kaplan Meier curve with log-rank test performed to compare survival outcomes among the two groups. RESULTS: A total of 23 studies were included in our quantitative analysis. 14 of these studies analyzed survival outcomes in patients undergoing palliative ERFA (213 patients) and the other 9 studies analyzed the survival data of patients undergoing palliative PRFA (114 patients) for untreated, unresectable cholangiocarcinoma. The mean survival of the ERFA group (12.0 ± 5.1 months) compared to the mean survival of the PRFA group (14.3 ± 7.5 months) was noted to be significantly different, favoring PRFA (difference = 2.3 ± 0.7 months, 95% CI 0.9–3.7, P = 0.001). However, no significant difference was noted on the Kaplan-Meier curve plotting longitudinal survival of ERFA (median: 12.0 months) and PRFA (median: 10.8 months, log-rank test z = 0.7 P = 0.5). CONCLUSION: Biliary RFA may be a viable, palliative option for patients who have untreated, unresectable cholangiocarcinoma with overall survival data exceeding that of published cholangiocarcinoma survival data. Our meta-analysis demonstrated a slight advantage for PRFA when comparing mean survival outcomes to ERFA, but there is no meaningful difference in longitudinal survival outcomes as demonstrated by the KM curve. However, given the absence of studies directly comparing ERFA with PRFA, further studies comparing the modalities are needed.Figure 1.: Forest Plot of survivals among patients treated with ERFA and PRFA for previously untreated, unresectable cholangiocarcinoma.Figure 2.: Kaplan-Meier survival curve comparing patients treated with ERFA and PRFA for previously untreated, unresectable cholangiocarcinoma.