Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy.
Department of Surgery and Organ Transplantation, Ospedale Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
Eur J Surg Oncol. 2014 May;40(5):567-575. doi: 10.1016/j.ejso.2013.12.006. Epub 2013 Dec 18.
Few papers focused on association between hepatolithiasis (HL) and cholangiocarcinoma (CCC) in Western countries. The aims of this paper are to describe the clinical presentation, treatment, and postoperative outcomes of CCC with HL in a cohort of Western patients and to compare the surgical outcomes of these patients with patients with CCC without HL.
Among 161 patients with HL from five Italian tertiary hepato-biliary centers, 23 (14.3%) patients with concomitant CCC were analyzed. The results of surgery in these patients were compared with patients with CCC without HL.
The 60.9% of patients with HL received the diagnosis of CCC intra- or postoperatively, with a resectability rate of 91.3%. The postoperative morbidity was 61.6%. The 1- and 3-year survival rates were 78.6% and 21.0%, respectively. The recurrence rate was 44.4% and the 3-year disease-free survival rates were 18.8%. The comparison with patients with CCC without HL showed a higher resectability rate (p = 0.02) and a higher frequency of earlier stage (p = 0.04) in CCC with HL. Biliary leakage was more frequent in CCC with HL group (p = 0.01) compared to CCC without HL group. We found no differences in overall and disease-free survival between the two groups.
Patients with HL and CCC showed a high resectability rate but a higher morbidity. Nevertheless, overall and disease-free survival of patients with CCC and HL showed no differences compared to those of patients with CCC without HL. Also in Western countries, HL needs a careful management for the possible presence of CCC.
在西方国家，很少有文献关注肝胆管结石症（HL）与胆管癌（CCC）之间的关系。本文旨在描述西方患者队列中 HCC 合并 HL 患者的临床表现、治疗方法和术后结果，并将这些患者的手术结果与无 HL 的 CCC 患者进行比较。
在来自意大利五个三级肝胆中心的 161 例 HL 患者中，分析了 23 例（14.3%）同时患有 CCC 的患者。将这些患者的手术结果与无 HL 的 CCC 患者进行比较。
60.9%的 HL 患者在术前或术后被诊断为 CCC，可切除率为 91.3%。术后发病率为 61.6%。1 年和 3 年生存率分别为 78.6%和 21.0%。复发率为 44.4%，3 年无病生存率为 18.8%。与无 HL 的 CCC 患者相比，HL 合并 CCC 患者的可切除率更高（p = 0.02），且早期分期更为常见（p = 0.04）。HL 合并 CCC 组的胆漏发生率高于无 HL 组（p = 0.01）。两组患者的总生存率和无病生存率无差异。
HL 合并 CCC 患者的可切除率较高，但发病率较高。然而，与无 HL 的 CCC 患者相比，HL 合并 CCC 患者的总生存率和无病生存率无差异。在西方国家，HL 也需要谨慎管理，因为可能存在 CCC。
