# Stent with radioactive seeds placement for obstructive hilar cholangiocarcinoma: comparison between unilateral and bilateral placement

## TL;DR

This study compares unilateral and bilateral stent placement with radioactive seeds for treating obstructive hilar cholangiocarcinoma and finds both approaches equally effective and safe.

## Contribution

The paper provides new comparative evidence on the clinical effectiveness and safety of unilateral versus bilateral radioactive seed stent placement for obstructive hilar cholangiocarcinoma.

## Key findings

- Unilateral and bilateral stent placement with radioactive seeds showed similar technical and clinical success rates.
- Stent patency and overall survival were comparable between the two placement approaches.
- Complication rates, including cholangitis and bleeding, were similar in both groups.

## Abstract

Biliary stenting with radioactive seed placement has become a frequently applied palliative intervention for patients with obstructive hilar cholangiocarcinoma (HC). Despite its increasing use, evidence comparing unilateral and bilateral stenting with radioactive seed placement remains limited.

This study aimed to compare clinical effectiveness and safety of unilateral and bilateral stenting with radioactive seed placement in patients with obstructive HC.

A retrospective review of consecutive patients treated with a stent with radioactive seed placement for obstructive HC between January 2022 and December 2024 was conducted. The patients were categorized into the unilateral or bilateral groups based on the stent placement approach. Technical success, clinical response, stent patency, overall survival, and complications were compared between the groups.

A total of 89 patients were analyzed, including 47 in the unilateral group and 42 in the bilateral group. Primary technical success was achieved in 91.5% and 95.2% of the patients, respectively (P = 0.68), while the secondary success rate was 100% for both groups. Clinical success rates were comparable (89.4% vs 90.5%; P >0.99). Median (interquartile range [IQR]) stent patency was 220 (160–256) days for unilateral placement and 210 (166–216) days for bilateral placement (P = 0.79). Median (IQR) overall survival was 255 (178–369) and 242 (175–362) days, respectively (P = 0.79). Incidence of cholangitis (10.6% vs 9.5%; P >0.99) and bleeding (4.3% vs 4.8%; P >0.99) did not differ between the groups.

Both unilateral and bilateral stenting with radioactive seed placement provide equivalent safety and efficacy in the management of obstructive HC.