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Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials

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Abstract

Background

Recently, there has been a burgeoning interest in radiofrequency ablation combined with stent (RFA + Stent) for unresectable malignant biliary obstruction (MBO). This study aimed to perform a meta-analysis to evaluate the efficacy and safety of RFA + Stent compared with biliary stent alone.

Methods

We searched PubMed, Cochrane Library, Embase, and Web of Science databases from their inception dates to June 20, 2021, for studies that compared RFA + Stent and stent alone for unresectable MBO. The main outcomes were survival, patency, and adverse effects. All meta-analyses were calculated using the random-effects model.

Results

A total of 19 studies involving 1946 patients were included in this study. Compared with stent alone, RFA + Stent was significantly associated with better overall survival (HR 0.55; 95% CI 0.48, 0.63; P < 0.00001), longer mean survival time (SMD 2.20; 95% CI 1.17, 3.22; P < 0.0001), longer mean stent patency time (SMD 1.37; 95% CI 0.47, 2.26; P = 0.003), higher stent patency at 6 months (OR 2.82; 95% CI 1.54, 5.18; P = 0.0008). The two interventions had similar incidence of postoperative abdominal pain (OR 1.29; 95% CI 0.94, 1.78; P = 0.11), mild bleeding (OR 1.28; 95% CI 0.65, 2.54; P = 0.48), cholangitis (OR 1.09; 95% CI 0.76, 1.55; P = 0.65), pancreatitis (OR 1.39; 95% CI 0.82, 2.38; P = 0.22). Furthermore, the serum bilirubin levels and stricture diameter after operations were significantly alleviated than before operations, but the degree of alleviation between the two groups were not significantly different (all P > 0.05).

Conclusion

Although the alleviation of serum bilirubin and stricture diameter did not differ between the two interventions, RFA + Stent can significantly improve the survival and stent patency with comparable procedure-related adverse events than stent alone. Thus, RFA + Stent should be recommended as an attractive alternative to biliary stent alone for patients with unresectable MBO.

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Abbreviations

CI:

Confidence interval

GRADE:

Grading of recommendations assessment, development, and evaluation

HR:

Hazard ratio

I 2 :

I-Squared

MBO:

Malignant biliary obstruction

NOS:

Newcastle–Ottawa Scale

OR:

Odds ratio

PRISMA:

Preferred reporting items for systematic review and meta-analysis

RCTs:

Randomized controlled studies

RFA + Stent:

Radiofrequency ablation combined with stent

ROB-2:

The revised cochrane risk of bias tool

SMD:

Standardized mean differences

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Funding

This research is supported by the Fundamental Research Funds for the Central Universities (Grant Nos. 2020jbkyzx001, lzujbky-2020-kb20); the Key Laboratory of Evidence-Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant No. GSEBMKT-2021KFKT03); Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Grant Number 2019GSZDSYS06.

Author information

Author notes

  1. Shaoming Song, Haojie Jin, and Qinghao Cheng contributed equally to this article.

Authors and Affiliations

  1. Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, 199 West Donggang R.D., Lanzhou, 730000, China

    Shaoming Song, Haojie Jin, Kun Lv, Ting Lei, Hongwei Tian, Wenwen Yang & Tiankang Guo

  2. Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China

    Shaoming Song, Qinghao Cheng, Shiyi Gong, Hongwei Tian, Xiaofei Li & Caining Lei

  3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 West Donggang R.D., Lanzhou, 730000, China

    Shaoming Song, Haojie Jin, Ting Lei, Wenwen Yang & Kehu Yang

  4. Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou, China

    Hongwei Tian

  5. Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China

    Kehu Yang

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Contributions

All patients participated in the interpretation of study results and approved the final version of the manuscript. TG and KY contributed to studying concepts and design. SS, HJ, and QC, contributed to data collection, statistical analysis, data interpretation, and the paper's drafting. SG, KL, WY, CL, TL, HT, and XL contributed to data collection.

Corresponding authors

Correspondence to Kehu Yang or Tiankang Guo.

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Disclosures

Shaoming Song, Haojie Jin, Qinghao Cheng, Shiyi Gong, Kun Lv, Wenwen Yang, Caining Lei, Ting Lei, Hongwei Tian, Xiaofei Li, Kehu Yang, and Tiankang Guo have no conflicts of interest or financial ties to disclose.

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Supplementary file1 (DOCX 27 KB)

Supplementary file2 (DOCX 28 KB)

Figure S1

Forest plot of subgroup analysis illustrating the mean stent patency based on metal or plastic stent (PNG 19 KB)

Figure S2

Funnel plots. A: overall survival; B: mean survival time; C: mean stent patency time; D: abdominal pain; E: cholangitis (PNG 417 KB)

Supplementary file5 (DOC 49 KB)

Supplementary file6 (DOC 66 KB)

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Song, S., Jin, H., Cheng, Q. et al. Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials. Surg Endosc 36, 5559–5570 (2022). https://doi.org/10.1007/s00464-022-09181-2

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