Sa1871 Local Recurrences and Complications After Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: Analysis Focused on Tumor Locations

Background: Palliation for inoperable malignant distal biliary strictures can be achieved with metallic and plastic biliary stents. There have been recent retrospective studies and randomized controlled trials that evaluated the mortality and morbidity in patients with metal versus plastic stents. This is a meta-analysis to pool the evidence for survival benefit and morbidity in metallic versus plastic stents in patients with malignant distal biliary strictures. Aim: Compare survival benefit and morbidity in patients with distal biliary strictures managed with metallic stents versus plastic stents. Method: Study Selection Criteria: Studies using metallic and plastic stents for palliation in patients with malignant distal biliary stricture / obstruction. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement. Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran's Q test based upon inverse variance weights. Results: Initial search identified 1376 reference articles, of which 91 were selected and reviewed. 10 studies (N=892) for metallic and plastic stents which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed an overall survival/ time to death in metallic stent group to be 157.3 days (95% CI = 148.9 to 165.6) compared to 120.6 days (95% CI = 114.3 to 126.9) in plastic stent group. Metal stents had a pooled complication rate of 3.83 % (95% CI = 3.52 to 4.14) compared to 2.17 % (95% CI = 1.91 to 2.42) for plastic stents. The pooled effects estimated by fixed and random effect models were similar. The p for chisquared heterogeneity for all the pooled accuracy estimates was > 0.10. Conclusions: In our meta-analysis of patients with malignant distal biliary strictures managed with palliative stenting, metallic stents might be associated with longer overall survival period compared to plastic stents.Metallic stenting seems to havemarginally higher percentage of complications when compared to plastic stenting.