Comparative analysis of percutaneus uni- and bilobar stenting in non-resectable malignant hilar obstruction

Objective. To conduct a comparative analysis of uni- and bilobar stenting in unresectable malignant biliary hilar obstruction.Material and methods. In the Botkin hospital (Moscow) from 2015 to 2019 antegrade self-expanding stenting was performed in 61 patients with unresectable malignant hilar obstruction. The patients were divided into 2 groups: group 1 - 27 had unilobar stenting and group 2 - 34 bilobar stenting. Patient characteristics: average age group 1 - 67.4±4.8, group 2 - 71.2±5.2; gender (m/f) group 1 - 12/15, group 2 - 19/15; bismuth type (II / IIIa / IIIb) group 1 - 6/11/10, group 2 - 4/18/12; ECOG group 1 - 2.4 ± 0.5, group 2 - 2.6 ± 0.4 (homogeneous groups).Results. Technical success: group 1 - 93.1%, group 2 - 82.9% (p = 0.293); clinical success: group 1 - 77.8%, group 2 - 88.2% (p = 0.147). The complication rate was slightly lower in the first group, 4 out of 27 (14.8%) versus 7 out of 34 in the second (20.6%) (p = 0.293). The frequency of stent dysfunctions in the first 3 months was 10 (35.7%) in group 1 and 7 (41.2%) in group 2 (p = 0.238). The stent functioning time was 241 days in group 1 and 319 days in group 2 (p = 0.325). Subgroup analysis revealed a significant difference (p = 0.019) in a more rapid decrease in bilirubin in the group of patients without cholangitis. The median survival was not statistically significant.Conclusion. As a result of the study, it can be concluded that the results of uni- and bilibar stenting do not significantly differ in the dynamics of laboratory parameters, the number of complications, and the duration of stent functioning.