Hepatolithiasis and intrahepatic cholangiocarcinoma：A review

Although the incidence of hepatolithiasis is decreasingas the pattern of gallstone disease changes in Asia,the prevalence of hepatolithiasis is persistently high,especially in Far Eastern countries. Hepatolithiasisis an established risk factor for cholangiocarcinoma（CCA）, and chronic proliferative inflammation may beinvolved in biliary carcinogenesis and in inducing theupregulation of cell-proliferating factors. With the useof advanced imaging modalities, there has been muchimprovement in the management of hepatolithiasis andthe diagnosis of hepatolithiasis-associated CCA （HLCCA）.However, there are many problems in managingthe strictures in hepatolithiasis and differentiatingthem from infiltrating types of CCA. Surgical resectionis recommended in cases of single lobe hepatolithiasiswith atrophy, uncontrolled stricture, symptom durationof more than 10 years, and long history of biliaryentericanastomosis. Even after resection, patientsshould be followed with caution for development ofHL-CCA, because HL-CCA is an independent prognosticfactor for survival. It is not yet clear whether hepaticresection can reduce the occurrence of subsequentHL-CCA. Furthermore, there are no consistent findingsregarding prediction of subsequent HL-CCA inpatients with hepatolithiasis. In the management ofhepatolithiasis, important factors are the reduction ofrecurrence of cholangitis and suspicion of unrecognizedHL-CCA.