Stenting with high-intensity focused ultrasound ablation for distal biliary obstruction caused by pancreatic carcinoma: a meta-analysis.

Introduction: Between 42% and 77% of patients with distal malignant biliary obstruction (MBO) suffer from pancreatic carcinoma (PC). Aim: To analyse the clinical efficacy of stenting accompanied by high-intensity focused ultrasound (HIFU) ablation in patients with distal MBO from PC. Material and methods: Relevant articles published through March 2021 were identified in the Pubmed, Cochrane Library, Embase, Wanfang, VIP, and CNKI databases. RevMan v5.3 and Stata v12.0 were used for the meta-analysis. Results: Twenty-nine articles were initially identified, and 5 of these were eventually included. These articles described 142 patients who underwent biliary stenting alone and 132 patients who underwent biliary stenting with HIFU ablation. The pooled Δ total bilirubin (TBIL) values were comparable between the 2 treatment groups (p = 0.10). The pooled stent dysfunction rate was significantly greater in the group with stenting alone (p = 0.03), and the pooled HR for the stent patency duration indicated that the duration of stent patency was increased in the stenting with HIFU ablation group (p < 0.0001). Overall survival rates were significantly longer in the stenting with HIFU ablation group (p < 0.0001). HIFU ablation was associated with an 80% pooled clinical response rate. The pooled cholangitis (p = 0.47) and pancreatitis (p = 0.56) rates were comparable between the 2 groups. Funnel plots did not reveal any significant evidence of endpoint-associated publication bias. Conclusions: Stenting with HIFU ablation increased both stent patency and overall survival in patients with distal MBO caused by PC compared to stenting alone.

Coil localization assisted wedge resection for pulmonary nodules in patients with malignant history.

ABSTRACT: We describe the clinical efficacy of coil localization (CL) assisted video-assisted thoracoscopic surgery (VATS) wedge resection (WR) for pulmonary nodules (PNs) in patients having a history of malignancy.In a total of 16 patients having PNs and malignant history, treatment was carried out using computed tomography (CT)-guided CL and subsequent VATS-guided WR procedures from November 2015 to December 2019. Technical success of CL, WR, and long-term outcomes was analyzed.A total of 21 PNs were localized (1.3 PNs per patient). A 100% technical success rate was achieved in this study for CT-guided CL. Each PN was localized with 1 coil. Two and 2 patients experienced pneumothorax and hemoptysis, respectively. VATS-guided WR also achieved a 100% technical success rate. Additional lobectomy was performed in 2 patients due to the invasive adenocarcinoma. The final diagnoses of these 21 PNs were adenocarcinoma (T1N0M0, n = 8), adenocarcinoma in situ (n = 2), pre-cancerosis (n = 1), metastasis (n = 2), and benign (n = 8). All patients underwent CT follow-up for 6 to 48 months. All patients were alive during the follow-up. The cumulative 6-, 12, and 24-month disease-free survival rates were 100%, 92.9%, and 47.3%, respectively. The median disease-free survival was 27.9 months.Pre-operative CT-guided CL can be safely and conveniently used to facilitate a high success rate of VATS-guided WR for PNs in patients with a malignant history. Among the PNs in patients with malignant history, primary lung cancer also occupied approximately half of the PNs.

Computed tomography-guided trans-pulmonary-hepatic approach coil localization for pulmonary nodules near the right lung base.

INTRODUCTION: Video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) is frequently used for removal of pulmonary nodules (PNs). Preoperative computed tomography (CT)-guided coil localization (CL) is often used for guidance. AIM: To evaluate the feasibility, safety, and effectiveness of CT-guided trans-pulmonary-hepatic approach CL of PNs near the right lung base. MATERIAL AND METHODS: Consecutive patients with PNs who underwent CT-guided CL followed by VATS-guided WR at our center from January 2018 to December 2020 were analyzed. RESULTS: One hundred and twenty-two patients with PNs underwent CT-guided CL followed by VATS-guided WR at our center. Of them, 5 (4.1%) patients had PNs near the right lung base and underwent the CT-guided trans-pulmonary-hepatic approach CL procedures. The technical success rate of CL was 100%. The VATS-guided WR was 100% successful. No patient required thoracotomy. CONCLUSIONS: CT-guided trans-pulmonary-hepatic approach CL for PNs located near the right lung base is technically feasible.

Stent with radioactive strand insertion for inoperable hilar cholangiocarcinoma: comparison of unilateral and bilateral insertion.

PURPOSE: To evaluate the relative clinical efficacy associated with the unilateral and bilateral insertion of a stent with a radioactive strand (RS) for the treatment of inoperable hilar cholangiocarcinoma (HCCA) patients. METHODS: From January 2017 to June 2020, consecutive patients diagnosed with inoperable HCCA underwent either unilateral or bilateral stent with RS insertion in our hospital. Outcomes compared between these groups included rates of technical success, clinical success, stent-related complications, stent patency and overall survival (OS). RESULTS: Unilateral and bilateral stent with RS insertion procedures were performed in 36 and 30 patients over the study period, respectively, with 100% technical and clinical success rates in both groups. No instances of procedure-related complications were reported. Cholangitis was observed in 7 (19.4%) and 6 (20%) patients in unilateral and bilateral groups (p= .955), respectively, while these groups exhibited respective cholecystitis in 2 (5.5%) and 1 (3.3%) cases, respectively (p=.662), and stent restenosis in 9 (25%) and 7 (23.3%) cases, respectively (p=.661). The median duration of stent patency in the unilateral and bilateral groups was comparable at 208 and 222 d, respectively (p=.889). All patients died over the course of follow-up, with similar median OS rates in the unilateral and bilateral groups of 250 and 246 d, respectively (p=.483). CONCLUSIONS: These data indicated that similar inoperable HCCA patient clinical outcomes are achieved following stent with RS insertion regardless of whether it is conducted via a unilateral or bilateral approach.