De Novo Cholangiocarcinoma after Hepatectomy for Hepatolithiasis: A Comparative Review of 124 cases

Abstract

Background: Prevalence of hepatolithiasis is common in South-East Asia, which mainly presented as recurrent pyogenic cholangitis, acute cholangitis and accredited a risk factor for cholangiocarcinoma. Hepatectomy is an acknowledged therapeutic option for hepatolithiasis. Methods: From January 2005 to December 2014, 124 patients, whom received hepatectomy for hepatolithiasis at Kaohsiung Chang Gung Memorial Hospital, had been reviewed and analyzed. Results: The presentation included left sided stones in 69%, right sided stones in 18% and bilateral in 13% of patients. Immediate stone clearance after operation was 95.2%. Hospital mortality rate was 3.2%, including one patient with post-operative liver failure and 3 with severe sepsis. Stone recurrence rate was 15.3%. Only one patient developed cholangiocarcinoma during the seventh year of follow-up. In comparison with other series of non-operative management, hepatectomy had higher stone clearance and reduced recurrence of stone and cholangitis, and reduced the risk of cholangiocarcinoma. Our incidence of de-novo cholangiocarcinoma was lowest among other hepatectomy series, with comparable rate of stone clearance and recurrent cholangitis. Conclusion: Hepatectomy for hepatolithiasis has highest stone clearance and lowest recurrent cholangitis rates. Low 5-year risk of cholangiocarcinoma can be achieved by early hepatectomy, including complete resection of the bile duct segment from the bifurcation, complete stone clearance and resection of strictures.