Factors affecting recurrence of intrahepatic duct stone and factors affecting development of cholangiocarcinoma after initial treatment of intrahepatic duct stone

Abstract

Background Hepatolithiasis causes recurrent cholangitis, biliary cirrhosis, and is an important risk factor for cholangiocarcinoma, which has a grave prognosis. Nevertheless, its intractable nature and high recurrence rate complicates treatment. Therefore, we investigated factors affecting recurrence of hepatolithiasis and factors affecting development of cholangiocarcinoma after treatment.

Methods Medical records of total 159 patients in Ajou University hospital from 1995 to 2014 were reviewed and types of hepatolithiasis were classified according to Tsunoda classification. Factors affecting complete removal of hepatolithiasis, recurrence of hepatolithiasis and development of cholangiocarcinoma in hepatolithiasis patients were analyzed.

Results The 159 patients consisted of 58 men and 101 women, with a mean age of 61.73 years. Median follow-up period was 53.69 months. Percutaneous transhepatic choledochoscopic stone lithotripsy (PTCS)and surgery were performed in 112 cases and in 34 cases, respectively. Peroral transpapillary endoscopic lithotripsy was also used in 3 patients and 10 patients were followed up without any treatment because of their comorbidities. Location of stones, treatment modality, Tsunoda classification, presence of liver atrophy, dilatation of stenosis during treatment and previous biliary surgery were not related to the possibility of complete stone removal in univariate and multivariate analysis. Recurrence rate was significantly different according to the location of stones, treatment modality, presence of liver atrophy, previous history of biliary surgery in univariate analysis. However, in multivariate analysis, previous history of biliary surgery was the only statistically significant factor. Patients who had undergone biliary surgery had 2.699 higher risk of recurrence than patients who had not. Cholangiocarcinoma was diagnosed in 7 (4.4%) patients. Four patients were diagnosed cholangiocarcinoma and hepatolithiasis simultaneously, and in the other three patients, cholangiocarcinoma developed during the follow-up period after treatment. Location of stones, Tsunoda classifications, previous history of previous biliary tract surgery, liver atrophy and complete stone removal were not related to development of cholangiocarcinomain multivariate analysis.

Conclusion We could not find the factors related to the complete stone removal in this study. Recurrence rate was significantly different according to the previous history of surgery. Patients who had undergone biliary surgery have 2.699 higher risk of recurrence than patients who had not. No factor was associated with occurrence of cholangiocarcinoma. Lastly, patients with a history of biliary tract surgery should be followed up more closely and carefully for recurrence than patients who do not.