Metal Stenting with or without Endobiliary Radiofrequency Ablation for Unresectable Extrahepatic Cholangiocarcinoma

Background: Retrospective comparison of stent patency and survival of patients with unresectable extrahepatic cholangiocarcinoma (CCA) treated by placement of self-expanding metal stents (SEMS) with or without endobiliary radiofrequency ablation (ERFA). Methods: Between January 2010 and September 2014, 76 patients with biliary obstruction caused by unresectable extrahepatic CCA (27 patients with Bismuth type I hilar CCA and 49 patients with distal CCA) were recruited into this study. Patients either received ERFA with SEMS (n = 34) or SEMS only (n = 42). Stent patency and survival of both groups were compared and predictors for overall survival were analyzed. Results: Demographic data were not different between the two groups. Complication rates of both groups were similar. Thirty-day stent patency was obtained in all patients and the median stent patency in the ERFA + SEMS group (9.5 months, 4.5 - 14.0 months) was significantly longer than that in the SEMS group (8.4 months, 4.9 - 11 months) (P = 0.024). The overall survival curve in the ERFA + SEMS group was significantly better than that of the SEMS group (P = 0.036). Multivariate Cox proportional hazards regression analyses showed that ERFA, tumor AJCC stage, extrahepatic CCA type, serum albumin and adjuvant chemotherapy were significant prognostic factors for overall patient survival. Conclusions: ERFA is effective for unresectable extrahepatic CCA and may improve metal stent patency and patient survival for unresectable extrahepatic CCA with biliary obstruction. Prospective randomized trials will be needed to confirm these findings.