Ann Liver Transplant.  2022 May;2(1):86-94. 10.52604/alt.22.0001.

Development of perihilar cholangiocarcinoma at 29 years after first hepatectomy for hepatolithiasis

• Kim SM
• Hwang S
• Kim Y
• Jwa EK

• KMID: 2560886
• DOI: http://doi.org/10.52604/alt.22.0001

Abstract

Hepatolithiasis is a known risk factor for intrahepatic cholangiocarcinoma. We present a case of a patient with perihilar cholangiocarcinoma that arose from the remnant hilar bile duct at 29 years after the initial hepatectomy for left-sided hepatolithiasis and at 16 years after completion left hepatectomy. A 66-year-old female patient was diagnosed with 4 cm-sized perihilar cholangiocarcinoma at follow-up studies. The tumor appeared to be confined at the right first-order hepatic duct without gross vascular invasion, thus surgical resection was performed with a curative intent. The tumor-containing right first-order hepatic duct was meticulously resected with concurrent removal of the caudate lobe. Cluster hepaticojejunostomy was performed to reconstruct the 4 cm-wide figure of 8-shaped intrahepatic bile duct openings. Significant bile leak occurred at the hepaticojejunostomy site, which was resolved with percutaneous pigtail drainage and percutaneous transhepatic biliary drainage. The patient was discharged from the hospital at 26 days after operation. The patient has been doing well for 12 months. She is currently undergoing scheduled adjuvant chemotherapy. The experience of our present case suggests that there is risk of de novo hepatobiliary malignancy after hepatic resection for hepatolithiasis. Thus, it is necessary to perform life-long follow-up studies for patients who have undergone hepatic resection for hepatolithiasis.

Keyword

Malignant transformation; Hepatolithiasis; Cholangiocarcinoma; Hepatic resection; Long-term follow-up