Intrahepatic cholangiocarcinoma in Taiwan

Abstract

We report our experience of the surgical treatment of intrahepatic cholangiocarcinoma (ICC) in Taiwanese patients. A total of 162 patients with histologically proven ICC were treated of whom 106 (65. 4%) had associated hepatolithiasis. Patients with hepatolithiasis were in earlier stages than those without hepatolithiasis. Two-thirds of the patients with hepatolithiasis presented with acute cholangitis, and two-thirds of those without hepatolithiasis presented with hepatomegaly. The rate of hepatic resection was 29.6% (48 of 162), and these rates were 31.1% and 26.8% for the patients with and without hepatolithiasis, respectively. Ninety-three percent of the patients with hepatolithiasis underwent common bile duct exploration, compared with 18% of those without hepatolithiasis. The surgical mortality rates were 3.7% (6/162), for all patients, and 3. 8% and 3.6% for patients with and without hepatolithiasis, respectively. The morbidity rate was much higher in the patients with hepatolithiasis (37.7% vs 16.1%). The 1-, 3-, and 5-year survival rates were 35.5%, 20.5%, and 16.5% in the patients with hepatolithiasis and 27.2%, 8.8%, and 7.8% in those without hepatolithiasis. Concomitant hepatolithiasis prevented precise diagnosis preoperatively and precipitated biliary sepsis, which affected resectability and increased postoperative morbidity. Hepatolithiasis per se did not influence long-term survival.

Laparoscopic left hemihepatectomy: a safety and feasibility study of 19 cases

“…The relationship between cholangiocarcinoma and hepatolithiasis has been reported [23,24]. In selected patients, hepatectomy may eradicate tumor and hepatolithiasis simultaneously, and provides the only chance for long-term survival.…”

Laparoscopic hepatectomy for hepatolithiasis: a feasibility and safety study in 29 patients

“…The relationship between hepatolithiasis and cholangiocarcinoma has been reported [23,24]. The presence of associated cholangiocarcinoma is the main factor compromising long-term survival in patients with hepatolithiasis.…”

“…Further work-up should be performed to rule out the possibility of associated cholangiocarcinoma. In selected patients, hepatectomy may eradicate tumor and hepatolithiasis simultaneously and provide the only chance for long-term survival [23,24]. In our patient with associated cholangiocarcinoma, the tumor was located in left lateral segment very close to segment IV, and laparoscopic left hemihepatectomy was performed with a 2-cm free margin.…”

Epidemiology of cholangiocarcinoma: An update focusing on risk factors

“…(30) Hepatolithiasis is strongly associated with cholangiocarcinoma with proportions varying from 10% in Japan to more than 60% in Taiwan. (68,69) Similarly, in the cholangiocarcinogenesis of other risk factors, bacterial infection and bile stasis, which are demonstrable in virtually all patients, underlie cholangiocarcinoma development. (30,70,71) This carcinogenic process is not limited to the intrahepatic lesions.…”