The Therapeutic Effect Of Endoscopic Radiofrequency Ablation Or Photodynamic Therapy Combined With Metal Stent Implantation In The Treatment Of Non-resectable Extrahepatic Cholangiocarcinoma

Objective:Retrospectively analyze and compare the efficacy and complications of endoscopic radiofrequency ablation combined with metal stent implantation(RFA + stent group),photodynamic therapy combined with metal stent implantation(PDT+stent group)and simple metal stent implantation(stent group)for advanced unresectable extrahepatic cholangiocarcinoma in the endoscopic center of Shanxi Provincial People’s hospital.Methods:We collected 76 patients with unresectable extrahepatic cholangiocarcinoma diagnosed in Shanxi Provincial People’s Hospital from September 2018 to January 2021.Among them,18 patients underwent ERCP guided photodynamic therapy combined with biliary metal stent implantation(PDT + stent group),28 patients underwent ERCP guided radiofrequency ablation combined with biliary metal stent implantation(RFA + stent group),and 30 patients underwent ERCP guided biliary metal stent implantation Stent implantation(stent group).Results:1.Baseline data comparison: there was no significant difference in age,sex,degree of biliary stricture before operation,liver function(including albumin,total bilirubin,glutamyl transpeptidase)between the three groups.2.Comparison of early postoperative complications: the incidence of abdominal pain,cholangitis and pancreatitis was similar among the three groups.3.The patency time of the stent was compared after operation: the patency time of PDT+stent group,RFA+ stent group and stent group was 7.1 months(6.5 months-7.6 months),6.9 months(6.5 months-7.2 months),4.1 months(3.3 months to 4.7 months).The patency time of the middle stent in PDT+ stent group and RFA+ stent group was significantly different from that of the simple stent group(Mann Whitney U test,P < 0.05),and there was no significant difference in the patency time of PDT+ stent group and RFA+ stent group(Mann Whitney U test,P > 0.05).4.Comparison of median survival time after operation:the median survival time of PDT +stent group,RFA + stent group and stent group was 8.8 months(5.8 months-13.2 months),8.9 months(5.9 months-12.1 months)and 6.4 months(3 months-10.2 months),respectively.The median survival time of PDT + stent group and RFA + stent group was significantly different from that of simple stent group(log rank test,P < 0.05),but there was no significant difference between PDT + stent group and RFA + stent group(log rank test,P > 0.05).Conclusions:1.ERCP guided photodynamic therapy or radiofrequency ablation combined with biliary metallic stent implantation can significantly prolong the stent patency time compared with biliary metallic stent implantation alone.There was no significant difference in stent patency time between photodynamic therapy and radiofrequency ablation.2.ERCP guided photodynamic therapy or radiofrequency ablation combined with biliary metal stent implantation can significantly prolong the median survival time of patients.There was no significant difference in median survival between photodynamic therapy and radiofrequency ablation.3.There was no significant difference in postoperative pain,pancreatitis,cholangitis and other complications among the three treatments.4.ERCP guided photodynamic therapy combined with stent implantation and ERCP guided radiofrequency ablation combined with stent implantation can be used as palliative treatment for patients with advanced extrahepatic cholangiocarcinoma.