The Biliary Stenting Strategy for the Unresectable Hilar Type of Intrahepatic Cholangiocarcinoma: A Single-Center Experience.

OBJECTIVES

Hilar-type intrahepatic cholangiocarcinoma (H-ICC), which originates from the large bile ducts, tends to invade the hepatic hilus and results in malignant hilar biliary obstruction (MHBO). Compared with hilar cholangiocarcinoma (HC), H-ICC exhibits a more aggressive biological behavior and a dismal prognosis. We aimed to investigate the optimal biliary stenting strategy for the treatment of unresectable H-ICC.

METHODS

Patients with unresectable H-ICC who received endoscopic biliary stenting (EBS) between January 2012 and June 2019 were retrospectively included in this study. The prognostic factors of survival outcome, clinical success, duration of stent patency, and EBS-related adverse events were analyzed.

RESULTS

Altogether 70 patients were enrolled, including 72.9% patients with multiple intrahepatic lesions and 44.3% with lymphatic metastasis. Jaundice control was achieved in 81.4% of the patients. Early cholangitis was the main treatment-related complication (17.1%). After successful stenting, systematic antitumor therapy was the only independent factor related to overall survival (hazard ratio [HR] 0.381, 95% confidence interval [CI] 0.218-0.668, p = 0.001). Plastic stenting was associated with clinical success (odds ratio [OR] 0.012, 95% CI 0.008-0.549, p = 0.012), stent patency (HR 6.773, 95% CI 2.221-20.653, p = 0.001), and early cholangitis (OR 5.000, 95% CI 1.006-24.841, p = 0.049). Bismuth classification IV was independently related to stent patency (HR 4.956, 95% CI 1.245-19.730, p = 0.023).

CONCLUSION

For H-ICC-induced MHBO, metal stent placement may achieve better biliary drainage and, combined with systemic antitumor therapies, may further improve patient survival.