Cholangiocarcinoma occurring in postoperative follow-up study of hepatolithiasis

Eight hundred and fifty cases of intrahepatic stones underwent surgery at Chang Gung Memorial Hospital between 1978 and 1987. Effective postoperative follow-up study was done in 409 cases were a 4- to 13-year period; of these 14 cases had tissue-proved cholangiocarcinoma by repeat laparotomy. Incidence of cholangiocarcinoma occurring in postoperative follow-up study of hepatolithiasis was 3.42%. Incidence in patients with post-operative retained and non-retained stones was 8.75% and 2.13%, respectively (P<0.05). The interval between operation for hepatolithiasis and cholangiocarcinoma was 40.6 ± 6.8 months. The location of stones and tumor was confirmed in the same lobe of liver in 92.8%. Image finding by postoperative T-tube cholangiography after surgery for hepatolithiasis was compatible with the location of cholangiocarcinoma in 86%. Pre-operative diagnosis of cholangiocarcinoma was made in six cases (43%) which had manifested by repeated cholangitis (71.5%), body weight loss (50%), anemia (50%), intractable pain (36%); one case had metastatic axillary nodes. Preoperative image diagnosis obtained by 1) sonography with hyperechoic mass in the liver parenchyma (2/12) 2) cholangiographic study (PTC or ERCP) showing obliteration, stricture or non-visualisation of intrahepatic duct (10/14); and 3) liver tumor with atrophy of one lobe, dilated duct with periductal enhancement or lymph node metastasis by CT scanning (4/6). Surgical procedures of cholangiocarcinoma were hepatic resection in four, palliative T-tube drainage in five and open tumor biopsy in five. Overall survival was 10 months, with a range of 1-48 months. Papillary-type adenocarcinoma seemed to have better prognosis.