Cholangiocarcinoma Associated with Hepatolithiasis

Kim, Young Woo; Han, Ho Seong; Lee, Han Chu; Yi, Sun Young; Choi, Yong Man; Kim, Ok Young

Abstract

BACKGROUND: The authors experienced cholangiocarcinomas associated with intrahepatic duct stones, so we reviewed and summarized the clinical features of these patients to shed light on the pathogenetic implication of hepatolithiasis on the development of cancer and to emphasize the role of hepatic resection in the management of hepatolithiasis.
METHODS
We performed 54 hepatic resections in 106 hepatolithiasis patients (51%) during 5 years from Sep. 1993 to Jun. 1998. The medical records of these patients were retrospectively reviewed. Clinical and demographic findings were analyzed and compared with those for all the hepatolithiasis cases. Statistical analysis was done with the chi-square test and Student t-test.
RESULTS
Eight patients out of 106 intrahepatic duct stone patients were associated with a cholangiocarcinoma (7.5%). The mean age was 59.5 13.4 years, and the male to female ratio was 1:3. Chief complaints were right upper quadrant pain (87.5%), fever (50%), jaundice (25%), indigestion (25%), and weight loss (12.5%). Clinically, 4 cases were presented as acute cholangitis, and 1 case was pancreatitis. The locations of the tumors were the right lobe in 2 cases, the left lobe in 3 cases, and the hilar portion in 3 cases. Preoperative diagnosis was clinically possible only in one case. Intraoperative diagnoses were possible in 5 cases with clinical suspicion of cancer and were confirmed by using frozen biopsy. Three cases were incidentally diagnosed as cancer by postoperative pathological reports. We missed the presence of cancer in these cases due to associated hepatic abscesses. The operations performed were a right lobectomy in 1 case, an extended right lobectomy in 1 case, a left lobectomy in 2 cases, a left lateral segmentectomy in 2 cases, and an extrahepatic bile duct resection with hepaticojejunostomy in 1 case. A palliative hepaticojejunostomy was done in 1 case, and the patient died 3 months later. Another patients survived for over 2 years after operations.
CONCLUSION
Aggressive hepatic resection for hepatolithiasis is recommended in view of highly coincident hidden cancer and the difficulty in diagnosis that cancer. Molecular and genetic investigations are needed to verify the etiological correlation between hepatolithiasis and cholangiocarcinomas.