Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
Erasmus University Medical Center, Erasmus MC Cancer Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands.
HPB (Oxford). 2023 Jul;25(7):798-806. doi: 10.1016/j.hpb.2023.03.011. Epub 2023 Mar 23.
For palliative drainage of inoperable perihilar cholangiocarcinoma (pCCA) uncovered metal stents are preferred over plastic stents. However, there is a lack of data on re-interventions at the long-term. The aim is to evaluate the potential difference in the number of re-interventions in patients surviving at least 6 months.
Retrospective study including patients with pCCA who underwent plastic stent placement(s) or had metal stent(s) in situ for at least 6 months. The primary outcome was the number of re-interventions per patient-year. A propensity score matching (1:1) analysis was performed using age, Bismuth classification, reason for inoperability, pathological confirmation, systemic therapy and initial approach (endoscopic vs percutaneous).
Patients in the metal stent group (n = 87) underwent fewer re-interventions compared with the plastic stent group (n = 40) (3.0 vs. 4.7 per patient-year; IRR, 0.64; 95% CI, 0.47 to 0.88). When only non-elective re-interventions were included, there was no significant difference (2.1 vs. 2.7; IRR, 0.76; 95% CI, 0.55 to 1.08). Results were similar in the propensity score-matched dataset.
This study shows that, also in patients with inoperable pCCA who survive at least 6 months, placement of metal stent(s) leads to fewer re-interventions in comparison with plastic stents.
对于无法手术的肝门周围型胆管癌（pCCA）的姑息性引流，uncovered 金属支架比塑料支架更受欢迎。然而，对于长期随访的再干预数据还很缺乏。本研究旨在评估至少生存 6 个月的患者中，再干预的数量是否存在差异。
本研究回顾性纳入了接受塑料支架置入或原位金属支架置入至少 6 个月的 pCCA 患者。主要研究终点为患者每年的再干预次数。采用倾向评分匹配（1:1）方法，比较年龄、Bismuth 分型、不可切除原因、病理证实、全身治疗和初始治疗方法（内镜下或经皮）对再干预的影响。
金属支架组（n=87）的患者每年的再干预次数明显少于塑料支架组（n=40）（3.0 次 vs. 4.7 次；IRR，0.64；95%CI，0.47 至 0.88）。仅纳入非择期再干预时，两组间差异无统计学意义（2.1 次 vs. 2.7 次；IRR，0.76；95%CI，0.55 至 1.08）。倾向评分匹配数据集的结果相似。
本研究表明，对于至少生存 6 个月的不可切除 pCCA 患者，与塑料支架相比，金属支架置入可减少再干预的次数。
