Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2024; 12(5): 913-921
Published online Feb 16, 2024. doi: 10.12998/wjcc.v12.i5.913
Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea
Tae In Kim, Sung Yong Han, Jonghyun Lee, Dong Uk Kim
Tae In Kim, Sung Yong Han, Jonghyun Lee, Dong Uk Kim, Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Sung Yong Han, Dong Uk Kim, Department of Internal Medicine, Pusan National University, College of Medicine, Yangsan 50612, South Korea
Author contributions: Kim TI, Han SY, Lee J, and Kim DU contributed to the design, writing and data analysis of the manuscript.
Supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea, No. HA20C0009.
Institutional review board statement: The study was reviewed and approved by the Biomedical Research Institute, Pusan National University Hospital, Institutional Review Board (Approval No. 2103-010-101).
Informed consent statement: We have no signed informed consent because this is a retrospective study and we analyzed medical records of patients in our center. We obtained a consent exemption for our research.
Conflict-of-interest statement: Dr. Kim reports grants from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea, during the conduct of the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Uk Kim, MD, PhD, Adjunct Associate Professor, Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, South Korea. amlm3@hanmail.net
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: November 22, 2023
Revised: December 6, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 16, 2024
Processing time: 104 Days and 22.8 Hours
ARTICLE HIGHLIGHTS
Research background

Cholangiocarcinoma (CCC) is a type of gastrointestinal malignancy that has a poor prognosis and is difficult to treat. It has a low possibility of operative resection for cure at the time of diagnosis, so research for systemic chemotherapy is underway, including the use of immune check point inhibitors. In East Asia, the incidence of CCC is increasing, but there are few methods for early diagnosis. Therefore, it is very important to recognize and estimate CCC risk factors.

Research motivation

In East Asia, intrahepatic duct (IHD) stones have been recognized as a risk factor for developing CCC. They block the normal outflow of bile, resulting in repetitive inflammation of liver parenchyma. Chronic inflammation of biliary tract and liver parenchyma are known to contribute to malignant change, so it is important to relieve the obstruction. There have been several studies about IHD stones and CCC, but most of them had a small number of subjects and few studies identified the correlation between removal of IHD stones and CCC development.

Research objectives

We wanted to perform a large cohort study about the effect of IHD stone removal on CCC development, including the optimal method for removal. We also analyzed the effect of medication for metabolic disease like diabetes mellitus, dyslipidemia, and hypertension.

Research methods

We retrospectively analyzed patients who were diagnosed with IHD stone with imaging tests and underwent removal in Pusan National University Hospital from January 2011 to December 2020. Based on medical records, we investigated the occurrence of CCC and factors affecting CCC development.

Research results

CCC occurred in 36 of the 397 enrolled patients. In multivariate analysis, carbohydrate antigen 19-9 > upper normal limit, carcinoembryonic antigen > upper normal limit, stones located in the left or both lobes, focal atrophy, and complete removal of IHD stones without recurrence were independent factors influencing CCC development. However, the type of removal method or medication for metabolic disease did not seem to affect CCC development.

Research conclusions

Regardless of methods, the complete removal of IHD stones without recurrence could reduce CCC development. Therefore, it is important to choose the optimal method for removal depending on the patient and follow up. Repetitive tests or procedures may be necessary.

Research perspectives

In the future, optimal method for removal of IHD stone regarding patient’s age, sex, social or economic factors and underlying disease should be studied. In addition, systemic treatment for CCC including cytotoxic or immune-targeted chemotherapy specific to CCC should be developed.