Endobiliary radiofrequency ablation for unresectable malignant biliary strictures: Survival benefit perspective

Endobiliary radiofrequency ablation (RFA) is an emerging technique in recent years for palliating malignant biliary strictures (MBS) unsuitable for surgical resection. To date, many clinical studies have shown good feasibility and safety of this therapy; but controversy exists on whether survival can be improved in patients with advanced MBS. A comprehensive review of the available literature demonstrates that RFA can effectively prolong the overall survival of extrahepatic cholangiocarcinoma (CCA) and ampullary cancer, especially in cases without distant metastasis. However, this topical therapy does not confer a survival benefit in patients with nonprimary bile duct malignancies, such as liver, gallbladder, or pancreatic cancers. Biliary RFA combined with systemic chemotherapy may have a synergistic effect on the outcome of inoperable CCA. Patients with locally advanced tumors rather than distant metastasis might benefit more from this combination therapy.