Abstract
BackgroundPatients with unresectable malignant biliary obstruction have limited life expectancy because of limited stent patency and tumor progression. The aim of our study was to retrospectively evaluate the safety and efficacy of combining intraductal RFA with biliary metal stent placement for patients with malignant biliary obstruction.MethodsPatients who received percutaneous intraductal RFA and biliary stent placement for malignant biliary obstruction between 2013 and 2015 were identified. Outcomes were stent patency, technique and clinical success rate, overall survival (OS) and complication rates. Kaplan-Meier and Cox regression analyses were used to examine the association of various factors with stent patency and OS. Complications and laboratory abnormalities were recorded.ResultsFifty patients were treated with percutaneous RFA and stent placement. The rates of technical success and clinical success were 98% and 92%, respectively. The median stent patency was 7.0 (95% confidence interval [CI]: 5.3, 8.7) months and OS was 5.0 (95% CI: 4.0, 6.0) months. On univariable analysis, previously cholangitis was an independent poor prognosis factor for recurrent biliary obstruction. OS was improved in patients who received more than one intervention compared to those who received only one intervention (log-rank P = 0.007), and in those treated without versus those treated with sequential chemotherapy (log-rank P = 0.017). On multivariable analysis, the occurrence of more than one intervention (P = 0.019) had independent prognostic significance for OS.ConclusionPercutaneous RFA and stent placement is a technically safe and feasible therapeutic option for the palliative treatment of malignant biliary obstruction. The long-term efficacy and safety of the procedure is promising, but further study is required via randomized and prospective trials.
Highlights
Patients with unresectable malignant biliary obstruction have limited life expectancy because of limited stent patency and tumor progression
We previously reported our early experience in managing patients with unresectable Bismuth types III and IV hilar cholangiocarcinoma using biliary radiofrequency ablation (RFA), and demonstrated that the long-term efficacy and safety is promising [21]
overall survival (OS) was improved in patients who received more than one intervention compared to those who received only one
Summary
Patients with unresectable malignant biliary obstruction have limited life expectancy because of limited stent patency and tumor progression. Patients with malignant biliary obstruction due to different types of tumors, including pancreatic, bile duct, gallbladder, and hepatocellular carcinomas, frequently have a poor prognosis in terms of quality of life and survival. These cancers are often surgically unresectable at the time of diagnosis, and those that are resected have high recurrence rates [1]. Placement of self-expandable metal stents (SEMS) is the standard of care in the palliative management of patients with malignant biliary strictures if their life expectancy is at least 3 months [2]. We examined the prognostic factors for stent patency in these patients
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