Irreversible electroporation treatment (IRE) with intraoperative biliary stent placement appears to be a safe and effective approach in treating unresectable perihilar cholangiocarcinoma (PHCC), according to research published in Frontiers in Oncology. It allows for the decompression of biliary obstruction without the need for PTBD tubes, a benefit that will likely improve quality of life.

Cholangiocarcinoma (CCA) is one of the most common liver-related cancers, second only to  hepatocellular carcinoma. Diagnosing this condition early remains a challenge because of its typically silent clinical characteristics. It is usually diagnosed only when obstructive jaundice occurs – a point in which the disease is already at an advanced stage. PHCC is one of the most common types of CCAs, accounting for approximately 50% of cases. 

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IRE is a procedure which uses high-voltage electric current to induce tumor apoptosis. It does not generate heat, thus allowing for the integrity of the connective tissue in the ablation zone to be preserved. 

This study investigated the use of IRE with intraoperative biliary stent placement to treat unresectable Bismuth type III/IV PHCC in a pair of  medical centers in Asia between June 2015 and July 2018. A total of 17 patients were recruited for this study. It focused on the perioperative clinical course, the efficacy of biliary decompression, and survival outcomes.

Read more about CCA prognosis 

The distribution of Bismuth classification among the patients was as follows: type IIIA (3), IIIB (1), and IV (13). There were no distant metastasis or ascites in all the patients recruited for this study. Of the 17 patients, 15 patients had preoperative unilateral or bilateral PTBD due to obstructive jaundice. The median duration of the IRE procedure was 300 minutes. Intraoperative hilar lymph node dissection revealed regional metastasis in 16 patients. 

Post-operatively, the results were as follow: 

  • Mean total serum bilirubin levels (mg/dL) were significantly lower post-operatively. On post-operative (POD) 7, it was 3.46 vs 4.54, (P =.007); on POD30 it was 1.21 vs 4.54 (P <.001); on POD90 it was 1.99 vs 4.54 (P <.001)
  • Mean serum carbohydrate antigen 19-9 (CA19-9, U/ml) levels were significantly higher post-operatively. On POD3, it was 518.8 vs 372.4 (P=.001); on POD30, it was 113.7 vs 372.4 (P <.001); on POD90, it was 63.9 vs 372.4 (P <.001). 
  • No cases of Clavien-Dindo grade III/IV adverse events or mortality were reported within 90 days after surgery. 
  • The median progression-free survival was 21.5 months, and the median overall survival was 27.9 months.
  •  All patients who survived for at least one year did so without needing to carry percutaneous biliary drainage (PTBD) tubes.

In cases of unresectable PHCC, the primary strategy for extending life expectancy is to slow tumor progression and avoid biliary obstruction. This study demonstrates that IRE with biliary stent placement is helpful in achieving this goal. 

Reference 

Yang PC, Chen YJ, Li XY, et al. Irreversible electroporation treatment with intraoperative biliary stenting for unresectable perihilar cholangiocarcinoma: a pilot study.Front Oncol. 2021 Jun 30;11:710536. doi: 10.3389/fonc.2021.710536.