Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Tan,Yong; Zhu,Jian‑Yong; Qiu,Bao‑An; Xia,Nian‑Xin; Wang,Jing‑Han

doi:10.3892/ol.2015.3589

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Authors:
- Yong Tan
- Jian‑Yong Zhu
- Bao‑An Qiu
- Nian‑Xin Xia
- Jing‑Han Wang
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Affiliations: Department of Hepatobiliary Surgery and Liver Transplantation Surgery, Navy General Hospital, Beijing 100048, P.R. China
Published online on: August 11, 2015 https://doi.org/10.3892/ol.2015.3589
Pages: 2537-2542

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Abstract

Hilar cholangiocarcinoma is often unresectable at the time of the initial diagnosis, and the provision of a definite palliative benefit is important in patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy (RT) prolonged the stent patency and survival time of patients. In total, the cases of 38 patients with unresectable hilar cholangiocarcinoma that underwent percutaneous biliary stenting at the Navy General Hospital were retrospectively reviewed in the present study. Uncovered metallic stenting (UMS) combined with RT was administered to 25 patients, and UMS alone was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure‑associated mortality rate was 2.6%. The median stent patency was 326 days in the UMS+RT group and 196 days in the UMS group (P=0.022). The UMS+RT group (median, 367 days) demonstrated a longer survival time compared with the UMS group (median, 267 days; P=0.025). Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with RT may prolong stent patency and patient survival time.

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1	Rerknimitr R, Angsuwatcharakon P, RatanachuEk T, Khor CJ, Ponnudurai R, Moon JH, Seo DW, PantongragBrown L, Sangchan A, Pisespongsa P, et al: Asia-pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol. 28:593–607. 2013. View Article : Google Scholar : PubMed/NCBI
2	Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz J, Youssef M, Klimstra D and Blumgart LH: Staging, resectability and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 234:507–519. 2001. View Article : Google Scholar : PubMed/NCBI
3	Rea DJ, MunozJuarez M, Farnell MB, Donohue JH, Que FG, Crownhart B, Larson D and Nagorney DM: Major hepatic resection for hilar cholangiocarcinoma: Analysis of 46 patients. Arch Surg. 139:514–525. 2004. View Article : Google Scholar : PubMed/NCBI
4	van Delden OM and Laméris JS: Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol. 18:448–456. 2008. View Article : Google Scholar : PubMed/NCBI
5	Singhal D, van Gulik TM and Gouma DJ: Palliative management of hilar cholangiocarcinoma. Surg Oncol. 14:59–74. 2005. View Article : Google Scholar : PubMed/NCBI
6	Paik WH, Park YS, Hwang JH, Lee SH, Yoon CJ, Kang SG, Lee JK, Ryu JK, Kim YT and Yoon YB: Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: A percutaneous versus endoscopic approach. Gastrointest Endosc. 69:55–62. 2009. View Article : Google Scholar : PubMed/NCBI
7	Ohnishi H, Asada M, Shichijo Y, Iijima N, Itobayashi E, Shimura K, Suzuki T, Yoshida S and Mine T: External radiotherapy for biliary decompression of hilar cholangiocarcinoma. Hepatogastroenterology. 42:265–268. 1995.PubMed/NCBI
8	Kuvshinoff BW, Armstrong JG, Fong Y, Schupak K, Getradjman G, Heffernan N and Blumgart LH: Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg. 82:1522–1525. 1995. View Article : Google Scholar : PubMed/NCBI
9	Golfieri R, Giampalma E, Fusco F, Galuppi A, Faccioli L, Galaverni C and Frezza G: Unresectable hilar cholangiocarcinoma: Multimodality treatment with percutaneous and intraluminal plus external radiotherapy. J Chemother. 16 Suppl 5:55–57. 2004.PubMed/NCBI
10	Piñol V, Castells A, Bordas JM, Real MI, Llach J, Montañà X, Feu F and Navarro S: Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: Randomized clinical trial. Radiology. 225:27–34. 2002. View Article : Google Scholar : PubMed/NCBI
11	DePalma GD, Pezzullo A, Rega M, Persico M, Patrone F, Mastantuono L and Persico G: Unilateral placement of metallic stents for malignant hilar obstruction: A prospective study. Gastrointest Endosc. 58:50–53. 2003. View Article : Google Scholar : PubMed/NCBI
12	Indar AA, Lobo DN, Gilliam AD, Gregson R, Davidson I, Whittaker S, Doran J, Rowlands BJ and Beckingham IJ: Percutaneous biliary metal wall stenting in malignant obstructive jaundice. Eur J Gastroenterol Hepatol. 15:915–919. 2003. View Article : Google Scholar : PubMed/NCBI
13	Tapping CR, Byass OR and Cast JE: Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score. Eur Radiol. 21:1948–1955. 2011. View Article : Google Scholar : PubMed/NCBI
14	Stoker J, Laméris JS and van Blankenstein M: Percutaneous metallic self-expandable endoprostheses in malignant hilar biliary obstruction. Gastrointest Endosc. 39:43–49. 1993. View Article : Google Scholar : PubMed/NCBI
15	Schima W, Prokesch R, Osterreicher C, Thurnher S, Függer R, Schöfl R, Havelec L and Lammer J: Biliary Wallstent endoprosthesis in malignant hilar obstruction: Long-term results with regard to the type of obstruction. Clin Radiol. 52:213–219. 1997. View Article : Google Scholar : PubMed/NCBI
16	Inal M, Akgül E, Aksungur E, Demiryürek H and Yağmur O: Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction. Complications, follow-up and reintervention in 154 patients. Acta Radiol. 44:139–146. 2003. View Article : Google Scholar : PubMed/NCBI
17	Inal M, Akgül E, Aksungur E and Seydaoğlu G: Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: Unilobar versus bilobar drainage. J Vasc Interv Radiol. 14:1409–1416. 2003. View Article : Google Scholar : PubMed/NCBI
18	Rossi P, Bezzi M, Rossi M, Adam A, Chetty N, Roddie ME, Iacari V, Cwikiel W, Zollikofer CL and Antonucci F: Metallic stents in malignant biliary obstruction: Results of a multicenter European study of 240 patients. J Vasc Interv Radiol. 5:279–285. 1994. View Article : Google Scholar : PubMed/NCBI
19	Inal M, Akgül E, Aksungur E, Demiryürek H and Yağmur O: Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction. Complications, follow-up and reintervention in 154 patients. Acta Radiol. 44:139–146. 2003. View Article : Google Scholar : PubMed/NCBI
20	Shinchi H, Takao S, Nishida H and Aikou T: Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma. J Surg Oncol. 75:89–94. 2000. View Article : Google Scholar : PubMed/NCBI
21	Kose F, Oguzkurt L, Besen A, Sumbul T, Sezer A, Karadeniz C, Disel U, Mertsoylu H and Ozyilkan O: Effectiveness of percutaneous metal stent placement in cholangiocarcinoma patients with midterm follow-up: Single center experience. Eur J Radiol. 81:1724–1727. 2012. View Article : Google Scholar : PubMed/NCBI
22	Isayama H, Tsujino T, Nakai Y, Sasaki T, Nakagawa K, Yamashita H, Aoki T and Koike K: Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma. World J Gastroenterol. 18:2364–2370. 2012. View Article : Google Scholar : PubMed/NCBI
23	Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, Nakai Y, Yamamoto N, Tada M, Yoshida H, et al: A prospective randomised study of ‘covered’ versus ‘uncovered’ diamond stents for the management of distal malignant biliary obstruction. Gut. 53:729–734. 2004. View Article : Google Scholar : PubMed/NCBI
24	Válek V, Kysela P, Kala Z, Kiss I, Tomásek J and Petera J: Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: A prospective randomised study. Eur J Radiol. 62:175–179. 2007. View Article : Google Scholar : PubMed/NCBI
25	Kaiser GM, Frühauf NR, Lang H, Sauerwein W, Sotiropoulos GC, Zöpf T, Grabellus F, Wittig A, Oldhafer KJ, Malagó M, et al: Impact of intraoperative radiotherapy (IORT) on survival of patients with unresectable hilar cholangiocarcinoma. Hepatogastroenterology. 55:1951–1954. 2008.PubMed/NCBI