Risk Factors for Cholangiocarcinoma After Initial Hepatectomy for Intrahepatic Stones.

Abstract

Aggressive hepatectomy is effective in treating intrahepatic stones and may minimize the deleterious consequences of subsequent cholangiocarcinoma (S-CCA). The risk factors of S-CCA after different methods of hepatectomy may vary with the resection scope of stone-affected segments. We reviewed the records of 981 patients of primary intrahepatic stones with elective hepatectomy from January 2000 to December 2010. The clinical characteristics of patients in the S-CCA group (n=55) and the control group (n=926) were compared. The uniformity between extent of liver resection (ELR) with stone-affected segments (SAS) was segmented into 2 varieties: ELR=SAS with ELR<SAS according to the different hepatic resection scopes. Cox regression model with forward selection was used to identify the risk factors of S-CCA. In the univariate analysis, significant differences were observed between the S-CCA and control groups concerning stone location (unilateral 43.6 and 65.2%, bilateral 56.4 and 34.8%), residual stones (32.7 and 11.6%), hepaticojejunostomy (43.6 and 30.9%), and uniformity between ELR with SAS (ELR=SAS 20.0 and 42.6%, ELR<SAS 80.0 and 57.4%). Residual stones [hazard ratio (HR) 2.101, P=0.016], hepaticojejunostomy (HR 1.837, P=0.026) and uniformity between ELR and SAS (HR 2.442, P=0.013) were independent prognostic factors for S-CCA by a Cox regression analysis with forward selection. In the subsection of ELR=SAS group, the 5- and 10-year postoperative tumor occurrence rates of unilateral and bilateral stones group were 0.9 versus 1.9% and 3.0 versus 4.1%, respectively (P=0.663, log-rank). In the other subsection of ELR<SAS group, the 5- and 10-year postoperative tumor occurrence rates of unilateral and bilateral stones group were 3.4 versus 3.9% and 6.8 versus 13.2%, respectively (P=0.047, log-rank), and the 5- and 10-year postoperative tumor occurrence rates of residual stones and non-residual stones group were 5.8 versus 3.0% and 16.0 versus 7.9%, respectively (P=0.015, log-rank). Patients who underwent aggressive hepatectomy and had ELR=SAS had better outcomes than those with ELR<SAS. In the patients with ELR=SAS, the S-CCA rates of unilateral and bilateral stones were low and comparable. However, patients with ELR<SAS and bilateral intrahepatic or residual stones should be monitored more carefully for high-risk factors of S-CCA.