SURGICAL METHODS AND PROGNOSTIC ANALYSIS OF ACCIDENTAL DISCOVERY OF BILE DUCT STONES AND CHOLANGIOCARCINOMA

Ahamed Yeasin*, Wu Wei, Yang Wei and Ni Qing*

ABSTRACT

Obejective: To investigate the surgical plan and curative effect analysis of cholangiocarcinoma accidentally discovered during the diagnosis and treatment of bile duct stones. Methods: Through retrospective analysis of 25 cases of bile duct stones admitted to our hospital, patients with cholangiocarcinoma found before or during the operation, the clinical data and relevant laboratory examination and imaging data of the patients were collected, and the surgical patients were classified according to whether the operation was performed or not. For the simple extrahepatic bile duct resection group and the combined liver resection group, the postoperative complications and prognosis of patients with extrahepatic bile duct resection and combined liver resection were compared. Results: All 25 patients underwent surgical resection. The surgical resection rate was 100%, of which R0 resection was 88.00% (22/25) and R1R2 resection was 12.00% (3/25). The total postoperative complication rate in the extrahepatic bile duct resection group was 13.63% (3/22), and the total complication rate in the combined hemihepatectomy group was 100% (3/3). Postoperative complications in the extrahepatic bile duct resection group were significantly lower than those in the combined hemihepatectomy group. The R0 resection rate of TNM stage I-II patients was significantly higher than that of stage III-IV (95.6% vs 50%). The RO resection rate of hilar cholangiocarcinoma in Bismuth type I patients was 100% (15/15), the resection rate of type II RO was 75% (3/4), and the resection rate of type IIIa RO was 50% (1/2). In the combined hemihepatectomy group, the type I RO resection rate was 100% (1/1), the type II RO resection rate was 66.66% (2/3), and the type IIIa RO resection rate was 0% (0/0). In the simple extrahepatic bile duct resection group, the R0 resection rate was 90.47% (19/21), and in combined hemihepatectomy or combined hemihepatectomy, the R0 resection rate was 75.00% (3/4). The 3-year and 5-year survival rates of the R0 resection group were significantly higher than those of the R1R2 resection group (P <0.05). Conclusion: For patients with bile duct tumors accidentally found due to bile duct stones, full evaluation should be done before surgery. Increasing the R0 resection rate can significantly improve the prognosis of patients.

Keywords: Cholelithiasis, laparoscopic choledocholithotomy, bile duct tumor, cholangiocarcinoma, survival rate.