Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit

Yiannis Kallis, Natalie Phillips, Alan Steel, Harry Kaltsidis, Panagiotis Vlavianos, Nagy Habib, David Westaby, Yiannis Kallis, Natalie Phillips, Alan Steel, Harry Kaltsidis, Panagiotis Vlavianos, Nagy Habib, David Westaby

Abstract

Background: Pancreatic carcinoma is often inoperable, carries a poor prognosis, and is commonly complicated by malignant biliary obstruction. Phase I/II studies have demonstrated good safety and early stent patency using endoscopic biliary radiofrequency ablation (RFA) as an adjunct to self-expanding metal stent (SEMS) insertion for biliary decompression.

Aim: To analyze the clinical efficacy of endobiliary RFA.

Methods: Retrospective case-control analysis was carried out for 23 patients with surgically unresectable pancreatic carcinoma and malignant biliary obstruction undergoing endoscopic RFA and SEMS insertion and 46 controls (SEMS insertion alone) in a single tertiary care center. Controls were stringently matched for age, sex, metastases, ASA/comorbidities. Survival, morbidity, and stent patency rates were assessed.

Results: RFA and control groups were closely matched-ASA 2.35 ± 0.65 versus 2.54 ± 0.50, p = 0.086; metastases 9/23 (39.1%) versus 18/46 (39.1%), p = 0.800; chemotherapy 16/23 (69.6%) versus 24/46 (52.2%), p = 0.203. Median survival in RFA group was 226 days (IQR 140-526 days) versus 123.5 days (IQR 44-328 days) in controls (p = 0.010). RFA was independently predictive of survival at 90 days (OR 21.07, 95% CI 1.45-306.64, p = 0.026) and 180 days (OR 4.48, 95% CI 1.04-19.30, p = 0.044) in multivariate analysis. SEMS patency rates were equivalent in both groups. RFA was well tolerated with minimal side effects.

Conclusions: Endoscopic RFA is a safe and efficacious adjunctive treatment in patients with advanced pancreatic malignancy and biliary obstruction and may confer early survival benefit. Randomized prospective clinical trials of this new modality are mandated.

Keywords: Biliary metal stent; Malignant biliary stricture; Obstructive jaundice; Therapeutic endoscopy.

References

    1. Gastrointest Endosc. 2010 Oct;72(4):748-54
    1. Dig Dis Sci. 2014 Dec;59(12):3099-102
    1. Dig Endosc. 2014 Jul;26(4):581-5
    1. World J Gastrointest Endosc. 2014 Jan 16;6(1):13-9
    1. N Engl J Med. 2011 May 12;364(19):1817-25
    1. Lancet. 1992 Dec 19-26;340(8834-8835):1488-92
    1. J Oncol. 2013;2013:910897
    1. Cancer Res. 2004 Jun 1;64(11):4024-9
    1. Surg Endosc. 2014 Mar;28(3):854-60
    1. Gut. 1995 Apr;36(4):618-21
    1. J Hepatobiliary Pancreat Sci. 2012 Sep;19(5):543-7
    1. Hepatobiliary Pancreat Dis Int. 2013 Aug;12(4):423-7
    1. HPB (Oxford). 2008;10(3):164-7
    1. Cardiovasc Intervent Radiol. 2013 Jun;36(3):814-9
    1. J Clin Oncol. 2009 Nov 20;27(33):5513-8
    1. Curr Opin Gastroenterol. 2013 May;29(3):305-11
    1. Arch Surg. 2006 Feb;141(2):181-90
    1. Gastrointest Endosc. 2011 Jan;73(1):149-53
    1. J Clin Oncol. 2007 Jun 1;25(16):2212-7
    1. Gut. 2007 Aug;56(8):1134-52
    1. Gut. 2002 Apr;50(4):549-57
    1. World J Gastroenterol. 2006 Jun 21;12(23):3716-21
    1. Gastroenterology. 2003 Nov;125(5):1355-63

Source: PubMed

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