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Percutaneous biliary stent with intraluminal brachytherapy versus palliative surgery in the management of extrahepatic cholangiocarcinoma

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Abstract

Background

To compare the efficacy and outcomes of self-expandable metallic stent combined with catheter-loaded iodine-125 seeds (SEMS-CL-125I) brachytherapy versus conventional palliative surgery (PS) in advanced extrahepatic cholangiocarcinoma (EHCC).

Methods

The retrospective analysis consisted of 101 advanced EHCC patients who received SEMS-CL-125I (n = 67) or underwent PS (n = 34). The clinical characteristics, postoperative complications and overall survival (OS) were compared between the two groups.

Results

Serum levels of bilirubin, transaminase, and albumin (ALB) were significantly improved at 1 month, 3 months, and 6 months postoperatively in both groups (all P < 0.05). At 1 month after operation, the level of ALB in SEMS-CL-125I group was significantly higher than that in PS group (39.07 ± 3.83 vs. 36.60 ± 5.58 g/L, P = 0.015). No statistically significant difference was found in postoperative overall complications between the two groups (P = 0.052). Length of hospital stay was significantly shorter (P < 0.001), hospital costs were significantly less (P < 0.001), and OS was significantly better (P = 0.029) in SEMS-CL-125I group compared to PS group. Multivariate analysis further identified PS (HR = 2.90, 95% CI 1.71–4.93, P < 0.001) and higher level of carbohydrate antigen 19-9 (HR = 2.67, 95% CI 1.36–3.79, P = 0.002) as independent predictors of worse OS.

Conclusion

SEMS-CL-125I significantly improves outcomes compared with PS and could be a safe and effective treatment for advanced EHCC.

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Abbreviations

ALB:

Albumin

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CA19-9:

Carbohydrate antigen 19-9

CCA:

Cholangiocarcinoma

CEA:

Carcinoembryonic antigen

DBIL:

Direct bilirubin

EHCC:

Extrahepatic cholangiocarcinoma

OS:

Overall survival

PS:

Palliative surgery

SEMS-CL-125I:

Self-expandable metallic stent combined with catheter-loaded iodine-125 seeds

STROBE:

STrengthening the Reporting of OBservational studies in Epidemiology

TBIL:

Total bilirubin

TNM:

Tumor node metastasis

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Acknowledgements

Not applicable.

Funding

This research was supported by the Science and Technological Fund of Anhui Province for Outstanding Youth (2008085J37), the First Affiliated Hospital of Bengbu Medical College Science Fund for Distinguished Young Scholars (2019byyfyjq05), the 512 Talent Training Program for Outstanding Young Teachers (by51201318), the National Natural Science Foundation of China (81600452), and the Key Project of Natural Science Foundation of Bengbu Medical College (BYKY1858ZD).

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China

    Yong Wang, Zhongran Man, Xiaosi Hu, Lei Zhou, Hao Jin, Huichun Liu & Qing Pang

Authors
  1. Yong Wang
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  2. Zhongran Man
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  3. Xiaosi Hu
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  4. Lei Zhou
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  5. Hao Jin
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  6. Huichun Liu
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  7. Qing Pang
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Contributions

WY, MZR, and HXS performed the data collection, analysis and drafted the manuscript. LHC and PQ designed the study and polished the manuscript. JH performed the data collection. ZL performed data analysis. All the authors approved the final version of this manuscript.

Corresponding authors

Correspondence to Huichun Liu or Qing Pang.

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The authors declare that they have no conflict of interest.

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Wang, Y., Man, Z., Hu, X. et al. Percutaneous biliary stent with intraluminal brachytherapy versus palliative surgery in the management of extrahepatic cholangiocarcinoma. Int J Clin Oncol 26, 933–940 (2021). https://doi.org/10.1007/s10147-021-01877-0

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  • DOI: https://doi.org/10.1007/s10147-021-01877-0

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