Untitled

Abstract

The association of hepatolithiasis (HL) and peripheral cholangiocarcinoma (PCC) has been well recognized. However, information concerning the impact of hepatolithiasis on patients with peripheral cholangiocarcinoma is sparse and therefore difficult to assess. A total of 162 consecutive patients with histologically proven peripheral cholangiocarcinoma were treated surgically at Chang-Gung Memorial Hospital between 1977 and 1994. Among them, 106 patients (65.4%) had associated hepatolithiasis (PCC + HL group), and the remaining 56 patients (34.6%) did not (the PCC - HL group). The differences in demographics, symptomatology, laboratory data, tumor staging, histological pattern, resectability rates, and long-term survival of these two groups were compared. The male to female ratio was 0.7 in the PCC + HL group and 1.3 in the PCC - HL group (P < 0.05). Two thirds of the PCC + HL group presented with acute cholangitis, whereas two thirds of the PCC - HL group presented with hepatomegaly (P < 0.01). Those patients in the PCC + HL group were in earlier stages than those of the PCC - HL group at the time of the initial diagnosis (P < 0.05). The resectability rate for the PCC + HL group was 31.1% and for the PCC - HL group, 26.8% (P > 0.05). Surgical mortality rates were 3.8% in the PCC + HL group and 3.6% in the PCC - HL group (P > 0.05). The morbidity rate was much higher in the PCC + HL group than in the PCC - HL group (P < 0.01). The 1-, 3-, and 5-year survival rates were 35.5%, 20.5%, and 16.5% in the PCC + HL group and 27.2%, 8.8%, and 7.8% in the PCC - HL group (P > 0.05). In conclusion, the presence of hepatolithiasis hindered an exact diagnosis of underlying cholangiocarcinoma preoperatively, precipitated biliary sepsis which affected resectability, and increased postoperative morbidity. Hepatolithiasis per se, however, did not influence the long-term survival.

Selection of surgical treatment types for intrahepatic duct stones

“…According to the previous studies, the incidence of postoperative complications was 12.0-38.5% after LR, 24.3-38.0% after HE and 2.1-40.0% after IHDE. 5 7 8 10 18 19 20 21 22 23 In this study, the incidence of postoperative complications was 29.9% after LR, 12.0% after IHDE and there were no cases of postoperative complications after HE. The incidence of complications in patients who underwent LR and IHDE was in concordance with the results of prior studies, but the patients who underwent HE showed a highly lower incidence of complications.…”

Sarcomatous carcinoma in biliary system

“…There was a report indicating that the prevalence of hepatolithiasis in the patients with ICC was up to 65.4%, which obviously confirmed the development from hepatolithiasis and chronic inflammation to carcinoma. [21] But the relationship between hepatolithiasis, choledocholithiasis, and the sarcomatoid changes of ICC, and finally SIC, remains a mystery. More clinical and genetic research is required.…”