title: Hepatolithiasis-associated cholangiocarcinoma: results from a multi-institutional national database on a case series of 23 patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Guglielmi
authors.affiliation: Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ruzzenente
authors.affiliation: Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Valdegamberi
authors.affiliation: Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bagante
authors.affiliation: Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Conci
authors.affiliation: Department of Surgery and Organ Transplantation, Ospedale Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Department of Surgery and Organ Transplantation, Ospedale Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Hepatobiliary Surgery Unit, Department of Surgery, Catholic University of the Sacred Heart School of Medicine, Roma, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giuliante
authors.affiliation: Department of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano 'Umberto I', Torino, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Capussotti
authors.affiliation: Department of Surgery-Liver Unit, Scientific Institute San Raffaele, Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Department of Surgery, Division of General Surgery "A", "GB Rossi" University Hospital, University of Verona Medical School, Verona, Italy. Electronic address: calogero.iacono@univr.it.
authors.forename: C
authors.initials: C
authors.lastname: Iacono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D016022:Case-Control Studies; D018281:Cholangiocarcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D020347:Lithiasis / Q000150:complications / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016896:Treatment Outcome
keywords: Cholangiocarcinoma; Hepatolithiasis; Liver surgery