Immediate and long-term outcomes of hepatectomy for hepatolithiasis.
OBJECTIVE
The aim of this study was to evaluate the perioperative and long-term results of hepatectomy for hepatolithiasis.


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.
Chen
Da-Wei
DW
Department of Surgery and Centre for the Study of Liver Disease, The University of Hong Kong Medical Centre, 102 Pokfulam Road, Hong Kong, China.
Tung-Ping Poon
Ronnie
R
Liu
Chi-Leung
CL
Fan
Sheung-Tat
ST
Wong
John
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018281:Cholangiocarcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D020347:Lithiasis / Q000150:complications / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome