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.
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Article info
Publication history
Accepted:
September 25,
2003
Hong Kong, ChinaIdentification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
