Long-term results of ERCP- or PTCS-directed photodynamic therapy for unresectable hilar cholangiocarcinoma
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and Other Interventional Techniques
Long‑term results of ERCP‑ or PTCS‑directed photodynamic therapy for unresectable hilar cholangiocarcinoma Zongyan Li1 · Xiaofeng Jiang1 · Hua Xiao2 · Shaoyi Chen1 · Wenfeng Zhu1 · Haiwu Lu1 · Liangqi Cao1 · Ping Xue1 · Haiyan Li3 · Dawei Zhang1 Received: 2 May 2020 / Accepted: 13 October 2020 © The Author(s) 2020
Abstract Background Photodynamic therapy (PDT) can be performed as palliative therapy for cholangiocarcinoma, while there is currently insufficient evidence for the efficacy. The aim of this study was to explore the clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP)- or percutaneous transhepatic cholangioscopy (PTCS)-directed PDT combined with stent placement for unresectable hilar cholangiocarcinoma. Methods A retrospective analysis was conducted on 62 patients with unresectable hilar cholangiocarcinoma. Thirty patients received PDT using hematoporphyrin combined with biliary stent placement (PDT+stent group), including 22 receiving ERCP-directed PDT and 8 receiving PTCS-directed PDT. Survival time, quality of life, and postoperative adverse events were compared to 32 patients receiving biliary stent placement alone (Stent-only group). Results After 42 months of follow-up, median survival time was significantly longer in the PDT+stent group than the Stentonly group (14.2 vs. 9.8 months, P = 0.003). In the PDT+stent group, the median survival time was longer in the 6 patients with recurrence after surgical resection than the 24 patients without prior surgical resection (20.0 vs. 13.0 months, P = 0.017). The QOL total scores was significantly higher in the PDT+stent group than the Stent-only group at postoperative 6, 9, and 12 months (P 38.5 °C)
Follow‑up Patients were followed up every 3 months from first operation until death by outpatient visit or by e-mail or telephone. Early withdrawals were excluded from the final analyses. The last follow-up visit was conducted in February 2016. All patients underwent laboratory tests one and two months after the operation and every three months thereafter. Quality of life was assessed by the FACT-HEP scale [16]. Survival time was defined as the interval between the first PDT or stent placement and death.
Statistical analysis Categorical variables were analyzed using the Chi-squared test or the Fisher exact test; continuous variables were
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Surgical Endoscopy
Fig. 2 PTCS-directed PDT procedure. A Percutaneous transhepatic cholangial drainage. Cholangiography showing the location of tumor stenosis. B, C As directed by a rigid guidewire, the skin and bile duct were expanded step-by-step using a percutaneous dilatation tube, and the 16Fr sheathing canal was retained. D, E After inserting the rigid
choledochoscope from the sheathing canal, the tumor was visualized directly under choledochoscopy, and the fiberoptic column diffuser was placed at the tumor location for PDT. F Internal and external drainage catheter were placed in the bile duct to ensure biliary drainage
analyzed using
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