Jeffrey Rebhun, MD, Edward C. Villa, MD; University of Illinois at Chicago, Chicago, IL
Introduction: Cholangiocarcinoma (CCA) represents nearly 3% of all gastrointestinal malignancies diagnosed in the United States each year. Due to its location and delayed presentation, CCA is associated with a poor prognosis and a median survival of 3-6 months for unresectable disease. Apart from chemotherapy, palliative measures such as percutaneous and endoscopic intraductal stenting have done little to prolong survival in these patients. Endoscopic radiofrequency ablation (ERFA) allows for delivery of thermal energy to the malignant tissue via endoscopic retrograde cholangiopancreatography (ERCP) to provide locoregional coagulative necrosis. This meta-analysis aims to evaluate pooled survival data of patients undergoing palliative ERFA in the treatment of unresectable CCA. Methods: A literature search was conducted using the PubMed database for published manuscripts and abstracts analyzing survival outcomes of patients undergoing ERFA with unresectable CCA. Only studies that provided a contingency of data allowing for extrapolation of outcomes related to cholangiocarcinoma were included. Results: A total of fifteen studies met our inclusion criteria and were included in quantitative analysis. A total of 247 patients underwent ERFA for palliative treatment of unresectable cholangiocarcinoma. Mean survival among these patients was 12.1 + 4.4 months with a median survival of 12 months. Discussion: ERFA may be a reasonable palliative therapy for those with previously untreated unresectable cholangiocarcinoma with evidence of median and mean survivals that exceed those in published literature for patients with unresectable cholangiocarcinoma. However, given the lack of available studies on this patient population, more data is needed to draw conclusions of survival benefit.
Figure 1: Kaplan-Meier survival curve for patients with unresectable, untreated cholangiocarcinoma treated with ERFA
Figure 2: Forest Plot of median survival (by study and cumulative) of patients with unresectable, untreated cholangiocarcinoma treated with ERFA.
Disclosures: Jeffrey Rebhun indicated no relevant financial relationships. Edward Villa: Olympus Corporation – Consultant.