Immediate and long-term outcomes of hepatectomy for hepatolithiasis

Surgery. 2004 Apr;135(4):386-93. doi: 10.1016/j.surg.2003.09.007.

Abstract

Objective: The aim of this study was to evaluate the perioperative and long-term results of hepatectomy for hepatolithiasis.

Patients and methods: Immediate and long-term outcomes of 103 consecutive patients with hepatolithiasis who underwent hepatectomy from 1989 to 2001 were analyzed. Immediate outcomes included stone clearance rate, operative morbidity, and mortality. Long-term results included stone recurrence rate and survival.

Results: The immediate stone clearance rate was 90%, and the final stone clearance rate was 98% after subsequent choledochoscopic lithotripsy by cutaneous stoma or T-tube route. The operative morbidity and hospital mortality rates were 28% and 2%, respectively. Multivariate analysis showed that right hepatectomy (P=.006) and preoperative hyperbilirubinemia (P=.038) were predictive of postoperative complications. Ten patients (10%) had associated cholangiocarcinoma (four known preoperatively) at the time of hepatectomy. With a median follow-up of 56 months (range 6-158), recurrent stones developed in eight patients and cholangiocarcinoma developed in three patients (range: 7-30 months postoperatively). Sixteen patients had died during the follow-up period, none of recurrent cholangitis. Cholangiocarcinoma was the only significant prognostic factor of long-term survival by Cox regression analysis.

Conclusions: Hepatectomy is a safe and effective treatment for hepatolithiasis, with a high immediate stone clearance rate and a low long-term stone recurrence rate. The presence of associated cholangiocarcinoma is the main factor compromising long-term survival in patients with hepatolithiasis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Cholangiocarcinoma / complications
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / surgery*
  • Female
  • Hepatectomy / methods*
  • Humans
  • Lithiasis / complications
  • Lithiasis / surgery*
  • Liver Diseases / complications
  • Liver Diseases / surgery*
  • Male
  • Middle Aged
  • Survival Analysis
  • Time Factors
  • Treatment Outcome