Aims:
Patients with an unresectable advanced hilar cholangiocellular carcinoma (CCC) suffer from a particularly short life expectancy. Endoscopic radiofrequency ablation (ERFA) of the malignant biliary obstruction may substantially prolong survival in these patients.
Methods:
All CCC cases with an ERFA of the biliary tract, performed at our tertiary referral center between a six-year period from 2012 to 2017, were retrospectively analyzed. For survival analysis using Kaplan-Meier method, these cases were compared to historical control cases who received the endoscopic standard treatment of sole stent application. Historical controls were chosen from an equal time-period (from 2006 and 2011) in which ERFA was not yet available at our tertiary referral center.
Results:
ERFA was performed in 32 patients with malignant biliary strictures that were mainly caused by Bismuth III and IV hilar CCCs (66%). 44% of these patients had multiple ERFAs accounting for an overall performance of 54 ERFAs. ERFA procedures were successfully completed in all cases, for a technical success rate of 100%. In all patients, endoscopic stents were applied (100%). Complications occurred in 18.5% of cases of which a post-interventional cholangitis was most frequently observed (11.1%) followed by cases with a post-interventional pancreatitis (3.7%). No mortalities occurred due to procedure-related side effects.
The case-control analysis revealed that the survival time of cases with unresectable Bismuth type III and IV hilar CCCs (n = 20) treated with stent placement in combination with ERFA significantly prolonged survival in comparison to controls (n = 22) treated with sole endoscopic stent placement (342 vs. 221 days; p = 0.046).
Conclusions:
ERFA significantly prolongs survival in patients with an unresectable Bismuth type III and IV hilar CCC. Therefore, it provides an easy-to-use, effective and safe palliative treatment option for these patients.
