Assessing the impact of radiofrequency ablation on hilar cholangiocarcinoma: a systematic review and meta-analysis

Hilar cholangiocarcinoma (HC) is a challenging malignancy with limited treatment options. Radiofrequency ablation (RFA) has emerged as a potential palliative treatment, but its efficacy and safety remain controversial. This systematic review and meta-analysis aimed to evaluate the impact of RFA + stent (RFA + S) and stent only (S-only) on HC patients.

We conducted a systematic search of PubMed, Embase, and Scopus databases for studies published up to December 2024. Eligible studies reporting RFA outcomes were included. The primary outcome was overall survival (OS). Secondary outcomes included stent patency (SP), stent dysfunction, and adverse events. We calculated hazard ratios (HR) and odds ratios (OR) using random-effects models.

This analysis included eleven studies ( n = 874 patients) that met the inclusion criteria. The pooled HR for OS was 0.74 (95% confidence interval [CI]: 0.61-0.89, P = 0.002), and SP was 0.77 (95% CI: 0.61-0.97; P = 0.03), showing a significant difference in favor of the RFA group. The OR of overall adverse events was 1.48 (95% CI: 0.59-3.72), cholangitis was 1.71 (95% CI: 0.78-3.75), pancreatitis was 1.03 (95% CI: 0.19-5.50), and liver abscess was 0.62 (95% CI: 0.07-5.24), showing no difference ( P > 0.05) between the two groups. Patients with chemotherapy showed better survival, indicated by an HR of 0.57 (95% CI: 0.40-0.81). Subgroup analyses also showed that randomized controlled trial (RCT) studies had no difference from non-RCT studies.

This meta-analysis suggests that the application of RFA offers better survival and stent patency benefits with comparable adverse events.