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Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review

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World Journal of Gastrointestinal Endoscopy 2023年第3期15卷 177-190页

作者： jeffrey rebhun Claire M Shin Uzma D Siddiqui Edward Villa Department of Gastroenterology Oregon Health and Sciences UniversityPortlandOR 97239United States Department of Medicine University of Illinois at ChicagoChicagoIL 60612United States Center for Endoscopic Research and Therapeutics University of ChicagoUniversity of Chicago MedicineChicagoIL 60637United States Department of Gastroenterology and Hepatology Northshore University Health SystemEvanstonIL 60201United States

BACKGROUND Endoscopic radiofrequency ablation(ERFA),percutaneous radiofrequency ablation(PRFA),and photodynamic therapy(PDT),when used in conjunction with conventional biliary stenting,have demonstrated a survival benefit in patients with unresectable *** To compare pooled survival outcomes,adverse event rates,and mean stent patency for those undergoing these *** A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting,biliary stenting alone,PRFA with stenting,and PDT with stenting for unresectable cholangiocarcinoma(CCA).RESULTS Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone(12.0±0.9 mo vs 6.8±0.3 mo,P<0.001)as well as statistically improved median survival time(13 mo vs 8 mo,P<0.001).Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone(P<0.001 and P=0.004,respectively).However,when comparing ERFA to PRFA,pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort(12.0+0.9 mo vs 8.1+2.1 mo,P<0.0001).Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting(11.3 mo vs 8.5 mo,P=0.02).CONCLUSION While further prospective,randomized studies are needed to assess efficacy of ERFA,our metaanalysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone,percutaneous radiofrequency ablation with biliary stenting,and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

关键词： Endoscopic radiofrequency ablation Percutaneous radiofrequency ablation Photodynamic therapy Cholangiocarcinoma Meta-analysis Systematic review

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