Jin Jin-Long, Li Wei, Wu Zhi-Xian, Feng An-Qiang, Li Hao
Interventional Department of Peripheral Vascular Disease, Gansu Provincial Hospital of Traditional Chinese Medicine (TCM), Lanzhou, China.
Department of Radiology, Xuzhou Central Hospital, Xuzhou, China.
Front Oncol. 2024 Oct 1;14:1412933. doi: 10.3389/fonc.2024.1412933. eCollection 2024.
While hilar cholangiocarcinoma (HCCA) patients commonly undergo radioactive stent (RS) insertion treatment, the relative benefits of unilateral versus bilateral RS insertion procedures remain to be established. Accordingly, this study was designed to evaluate the relative safety and efficacy of percutaneous bilateral and unilateral RS insertion for patients with HCCA.
In total, 126 HCCA patients who underwent unilateral (n=64) or bilateral (n=62) RS insertion from January 2017 - December 2021 were included in this analysis. Treatment efficacy and long-term outcomes were compared between groups. The primary endpoint was stent patency, and the secondary endpoints included technical success rate, clinical success rate, local control rate, overall survival (OS), and complications.
The respective technical success rates in the unilateral and bilateral groups were 90.6% (58/64) and 93.5% (58/62) (P = 0.782). The clinical success rates were 82.8% and 86.2% in unilateral and bilateral groups, respectively (P = 0.608). Both groups exhibited comparable medial post-intervention bilirubin levels (100 vs. 99 μmol/L; P = 0.501), and restenosis occurred in 12 (20.7%) and 15 (25.9%) patients over the follow-up interval (P = 0.510). The stent reintervention rate was significantly higher in the unilateral group than bilateral group (66.7% vs. 0.0%, P < 0.001). The median stent patency in the unilateral and bilateral groups was 189 and 210 days, respectively (P = 0.796), while the median OS interval was 222 and 229 days, respectively (P = 0.969). Comparable cholangitis (17.2% vs. 22.4%, P = 0.485) and cholecystitis (3.4% vs. 3.4%, P = 1.000) rates were also detected in these two groups.
In summary, HCCA patients exhibit comparable efficacy when undergoing unilateral and bilateral radioactive stenting, suggesting that unilateral RS can be routinely performed owing to the simpler nature of this procedure.
虽然肝门部胆管癌（HCCA）患者通常接受放射性支架（RS）植入治疗，但单侧与双侧RS植入手术的相对益处仍有待确定。因此，本研究旨在评估经皮双侧和单侧RS植入对HCCA患者的相对安全性和疗效。
本分析纳入了2017年1月至2021年12月期间接受单侧（n = 64）或双侧（n = 62）RS植入的126例HCCA患者。比较两组的治疗效果和长期预后。主要终点是支架通畅率，次要终点包括技术成功率、临床成功率、局部控制率、总生存期（OS）和并发症。
单侧组和双侧组的技术成功率分别为90.6%（58/64）和93.5%（58/62）（P = 0.782）。单侧组和双侧组的临床成功率分别为82.8%和86.2%（P = 0.608）。两组干预后血清胆红素水平相当（100 vs. 99 μmol/L；P = 0.501），随访期间分别有12例（20.7%）和15例（25.9%）患者发生再狭窄（P = 0.510）。单侧组的支架再干预率显著高于双侧组（66.7% vs. 0.0%，P < 0.001）。单侧组和双侧组的支架中位通畅时间分别为189天和210天（P = 0.796），而中位OS时间分别为222天和229天（P = 0.969）。两组的胆管炎（17.2% vs. 22.4%，P = 0.485）和胆囊炎（3.4% vs. 3.4%，P = 1.000）发生率相当。
总之，HCCA患者接受单侧和双侧放射性支架植入时疗效相当，这表明由于单侧RS手术操作更简单，可常规进行。
