Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?

AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.METHODS:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection.Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct(>2 cm).Late results and risk factors for recurrence of symptoms or stones were evaluated.RESULTS:There was no operative mortality.After a mean follow-up of 50.3 mo,good late results were observed in 82.9% of patients;all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms(P=0.0006).Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%,respectively(P<0.001).CONCLUSION:Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution.Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct.

Development and validation of a machine learning-based nomogram for prediction of intrahepatic cholangiocarcinoma in patients with intrahepatic lithiasis

Background:Accurate diagnosis of intrahepatic cholangiocarcinoma(ICC)caused by intrahepatic lithiasis(IHL)is crucial for timely and effective surgical intervention.The aim of the present study was to develop a nomogram to identify ICC associated with IHL(IHL-ICC).Methods:The study included 2,269 patients with IHL,who received pathological diagnosis after hepatectomy or diagnostic biopsy.Machine learning algorithms including Lasso regression and random forest were used to identify important features out of the available features.Univariate and multivariate logistic regression analyses were used to reconfirm the features and develop the nomogram.The nomogram was externally validated in two independent cohorts.Results:The seven potential predictors were revealed for IHL-ICC,including age,abdominal pain,vomiting,comprehensive radiological diagnosis,alkaline phosphatase(ALK),carcinoembryonic antigen(CEA),and cancer antigen(CA)19-9.The optimal cutoff value was 2.05μg/L for serum CEA and 133.65 U/mL for serum CA 19-9.The accuracy of the nomogram in predicting ICC was 82.6%.The area under the curve(AUC)of nomogram in training cohort was 0.867.The AUC for the validation set was 0.881 from The Second Affiliated Hospital of Wenzhou Medical University,and 0.938 from The First Affiliated Hospital of Fujian Medical University.Conclusions:The nomogram holds promise as a novel and accurate tool to predict IHL-ICC,which can identify lesions in IHL in time for hepatectomy or avoid unnecessary surgical resection.