title: Incidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative benign hepatolithiasis.
abstract: OBJECTIVE
  Despite hepatolithiasis being a risk factor for biliary neoplasm including cholangiocarcinoma, the incidence of underlying biliary neoplasm is unknown in patients with preoperative benign hepatolithiasis. The aim of this study was to evaluate the incidence of underlying biliary neoplasm in patients who underwent major hepatectomy for preoperative benign hepatolithiasis.
  
  
  METHODS
  Between March 2005 and December 2015, 73 patients who underwent major hepatectomy for preoperative benign hepatolithiasis were enrolled in this study. The incidence and pathological differentiation of concomitant biliary neoplasm were retrospectively determined by review of medical records. Postoperative complications after major hepatectomy were evaluated.
  
  
  RESULTS
  Concomitant biliary neoplasm was pathologically confirmed in 20 patients (27.4%). Biliary intraepithelial neoplasia (BIN) was detected in 12 patients (16.4%), and 1 patient (1.4%) had intraductal papillary mucinous neoplasm (IPMN), as the premalignant lesion. Cholangiocarcinoma was pathologically confirmed in 7 patients (9.6%). Preoperative imaging of the 73 patients revealed biliary stricture at the first branch of bile duct in 31 patients (42.5%), and at the second branch of bile duct in 39 patients (53.4%). Postoperative complications developed in 14 patients (19.1%). Almost all patients recovered from complications, including intra-abdominal abscess (9.6%), bile leakage (4.1%), pleural effusion (2.7%), and wound infection (1.4%). Only 1 patient (1.4%) died from aspiration pneumonia.
  
  
  CONCLUSIONS
  The incidence of underlying biliary neoplasm was not negligible in the patients with hepatolithiasis, despite meticulous preoperative evaluations.
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Hwasun, Korea.
authors.forename: Hyeong Min
authors.initials: HM
authors.lastname: Park
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Hwasun, Korea.
authors.forename: Young Hoe
authors.initials: YH
authors.lastname: Hur
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Hwasun, Korea.
authors.forename: Chol Kyoon
authors.initials: CK
authors.lastname: Cho
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Hwasun, Korea.
authors.forename: Yang Seok
authors.initials: YS
authors.lastname: Koh
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Hwasun, Korea.
authors.forename: Hee Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Hwasun, Korea.
authors.forename: Eun Kyu
authors.initials: EK
authors.lastname: Park
keywords: Biliary neoplasm; Cholangiocarcinoma; Hepatolithiasis; Major hepatectomy