TY - JOUR
T1 - Cholangiocarcinoma risk as long-term outcome after hepatic resection in the hepatolithiasis patients
AU - Kim, Hyo Jung
AU - Kim, Jae Seon
AU - Suh, Sang Jun
AU - Lee, Beom Jae
AU - Park, Jong Jae
AU - Lee, Hong Sik
AU - Kim, Chang Duck
AU - Bak, Young Tae
N1 - Publisher Copyright:
© 2015 Société Internationale de Chirurgie.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background: Hepatolithiasis is a well-known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. Methods: Among a total of 257 patients who received treatment for hepatolithiasis, 236 patients were eligible for analysis. Exclusion criteria were follow-up period less than 9 months, preoperative diagnosis of cholangiocarcinoma, occurrence of cholangiocarcinoma within 1 year after treatment. Completeness of stone clearance was defined when there was no intrahepatic duct stone during whole follow-up period. A retrospective study was done to analyze the patients' characteristics, the results and complications of the procedure, and the long-term outcomes for these patients. Kaplan-Meier method and cox proportional regression were used for statistical analysis. Results: 95 patients underwent hepatic resection (resection group) and 144 patients did not (non-resection group). Complete stone clearance was 71 % (67/95) in resection group and 41 % (58/141) in non-resection group (p < 0.001). The incidence of cholangiocarcinoma was 6.8 % (16/236) during follow-up period (mean 41 ± 41 months). Cholangiocarcinoma occurred 6.3 % (6/95) and 7.1 % (10/141) in resection and non-resection group, respectively. There was no significant difference in survival between two groups (p = 0.254). In analysis of according to completeness of stone clearance regardless of treatment modality, cholangiocarcinoma incidence was higher in patients with residual stone (10.4 %) than complete stone removal (3.3 %) (p = 0.263). On multivariate analysis, none of the factors (age, gender, CA19-9, stone location, bile duct stenosis, liver atrophy, stone recurrence, residual stone, and hepatic resection) showed relationship with the incidence of cholangiocarcinoma. Conclusion: Hepatic resection for hepatolithiasis is considered to have a limited value in preventing cholangiocarcinoma and the patients should be carefully followed even after hepatic resection. A combination of different treatment modalities is necessary to decrease the residual stone and improve the outcome of the patients with hepatolithiasis.
AB - Background: Hepatolithiasis is a well-known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. Methods: Among a total of 257 patients who received treatment for hepatolithiasis, 236 patients were eligible for analysis. Exclusion criteria were follow-up period less than 9 months, preoperative diagnosis of cholangiocarcinoma, occurrence of cholangiocarcinoma within 1 year after treatment. Completeness of stone clearance was defined when there was no intrahepatic duct stone during whole follow-up period. A retrospective study was done to analyze the patients' characteristics, the results and complications of the procedure, and the long-term outcomes for these patients. Kaplan-Meier method and cox proportional regression were used for statistical analysis. Results: 95 patients underwent hepatic resection (resection group) and 144 patients did not (non-resection group). Complete stone clearance was 71 % (67/95) in resection group and 41 % (58/141) in non-resection group (p < 0.001). The incidence of cholangiocarcinoma was 6.8 % (16/236) during follow-up period (mean 41 ± 41 months). Cholangiocarcinoma occurred 6.3 % (6/95) and 7.1 % (10/141) in resection and non-resection group, respectively. There was no significant difference in survival between two groups (p = 0.254). In analysis of according to completeness of stone clearance regardless of treatment modality, cholangiocarcinoma incidence was higher in patients with residual stone (10.4 %) than complete stone removal (3.3 %) (p = 0.263). On multivariate analysis, none of the factors (age, gender, CA19-9, stone location, bile duct stenosis, liver atrophy, stone recurrence, residual stone, and hepatic resection) showed relationship with the incidence of cholangiocarcinoma. Conclusion: Hepatic resection for hepatolithiasis is considered to have a limited value in preventing cholangiocarcinoma and the patients should be carefully followed even after hepatic resection. A combination of different treatment modalities is necessary to decrease the residual stone and improve the outcome of the patients with hepatolithiasis.
UR - http://www.scopus.com/inward/record.url?scp=84929084746&partnerID=8YFLogxK
U2 - 10.1007/s00268-015-2965-0
DO - 10.1007/s00268-015-2965-0
M3 - Article
C2 - 25648078
AN - SCOPUS:84929084746
VL - 39
SP - 1537
EP - 1542
JO - World Journal of Surgery
JF - World Journal of Surgery
SN - 0364-2313
IS - 6
ER -