Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Clin J Gastroenterol. 2023 Dec;16(6):908-912. doi: 10.1007/s12328-023-01845-3. Epub 2023 Aug 24.
An 84-year-old woman with cerebrovascular disease, dementia, and chronic kidney disease developed jaundice because of localized extrahepatic cholangiocarcinoma (eCCA) at the lower bile duct. Aggressive treatment, including surgery and chemotherapy, was difficult because of the underlying disease; therefore, only metal stent placement with endobiliary radiofrequency ablation (RFA) was performed. Subsequently, six additional RFA sessions were performed 12, 16, 24, 27, 33, and 36 months after the initial RFA using the same settings as the first RFA session. All these procedures were performed for tumor ingrowth. Computed tomography performed 42 months after the initial procedure revealed no stent with stricture resolution and no other metastatic lesion. Thereafter, no recurrence or adverse events have been observed with persisting stent-free status until the reporting of this study (72 months after the initial procedure). This is the first report of a stent-free status and long-term survival in a patient with localized eCCA that was achieved using only endobiliary RFA without any other anti-tumor treatment. Although several problems and issues associated with endobiliary RFA remain unelucidated, it may be a useful therapeutic option for early and localized eCCA in poor surgical candidates.
一位 84 岁女性，患有脑血管疾病、痴呆和慢性肾脏病，因下段胆管局限性肝外胆管癌（eCCA）而出现黄疸。由于基础疾病，难以进行积极的治疗，包括手术和化疗；因此，仅进行了金属支架置入和胆管内射频消融（RFA）。随后，在初始 RFA 后 12、16、24、27、33 和 36 个月，使用与初始 RFA 相同的设置，进行了另外 6 次 RFA 治疗。所有这些程序都是为了肿瘤生长而进行的。初始手术后 42 个月进行的计算机断层扫描显示支架无狭窄缓解，也没有其他转移病灶。此后，在报告本研究时（初始手术后 72 个月），持续无支架且无复发或不良事件。这是首例仅使用胆管内 RFA 而不进行任何其他抗肿瘤治疗，即可实现无支架状态和局限性 eCCA 长期生存的病例报告。尽管胆管内 RFA 仍存在一些未阐明的问题和问题，但对于手术困难的早期和局限性 eCCA，它可能是一种有用的治疗选择。
