Choledochoscopic heat-probe therapy: an adjunctive palliative treatment for intrahepatic cholangiocarcinoma with hepatolithiasis.

From 1983 to 1988, 20 out of 440 patients undergoing surgery for hepatolithiasis were discovered to have proximal bile duct adenocarcinomas, an incidence of 4.54%. Pre- and intra-operative diagnosis in all patients was hepatolithiasis. Four patients had left lateral segmentectomies and were found to have intrahepatic cholangiocarcinoma on subsequent histopathologic studies. In 16 patients, choledocholithotomy and biliary drainage were performed requiring post-operative choledochoscopy for removal of residual intrahepatic stones. Follow-up choledochoscopies revealed bile duct cancers in the biopsy specimens obtained. All patients refused any form of reoperation, eight patients accepted heat-probe therapy as an alternative, and were classified under group A. Group B patients (n = 8) refused any form of treatment whatsoever and agreed to periodic follow-ups and maintenance of external biliary drainage. At the half year follow-up, group A had a survival rate of 100%, whereas group B had a survival rate of 62.5%. At the end of one year, there was one survivor in group B, while group A has 2, 3 and 4 year survival rates of 50%, 37.5% and 12.5% respectively. This study has shown that gross and histological documentation of unsuspected proximal biliary cancers in hepatolithiasis patients are possible with the use of the flexible choledochoscope. Furthermore, we believe that choledochoscopic cauterization of tumors with the heat-probe is a reasonable palliative that can lead to appreciably longer survival rates.