| Theme | Up‒to‒date of the Protection of Gastroenterological Cancers | |
|---|---|---|
| Title | Cholelithias and Biliary Tract Cancer | |
| Publish Date | 2015/10 | |
| Author | Masahiko Komagome | Department of Hepato‒Biliary‒Pancreatic & Pediatric Surgery, Saitama Medical University and Saitama Medical Center |
| Author | Yoshifumi Beck | Department of Hepato‒Biliary‒Pancreatic & Pediatric Surgery, Saitama Medical University and Saitama Medical Center |
| Author | Fumiaki Ozawa | Department of Hepato‒Biliary‒Pancreatic & Pediatric Surgery, Saitama Medical University and Saitama Medical Center |
| Author | Akira Maki | Department of Hepato‒Biliary‒Pancreatic & Pediatric Surgery, Saitama Medical University and Saitama Medical Center |
| [ Summary ] | The relationship between cholelithiasis and biliary malignancies, such as gallbladder cancer and bile duct cancer, is still controversial. A study of a Japanese cohort showed that cholecystolithiasis is a risk factor for biliary malignancy, and this finding was supported by a foreign meta‒analysis of risk factors for gall bladder cancer. However, some reports have shown that the incidence rate of biliary malignancy during the observational period among asymptomatic cholecystolithiasis patients was not different from the general population. A large stone, more than 3 cm in diameter, multiple gallbladder stones, and porcelain gallbladder are widely established risk factors for gallbladder cancer；however, preemptive cholecystectomy is not recommended for asymptomatic cholecystolithiasis as per the Japanese therapeutic guideline for gallbladder stones. The presence of intra‒hepatic biliary stones is a risk factor for intra‒hepatic bile duct cancer. Intra‒hepatic biliary stones with severe hepatic atrophy and greater than 50 % reduction of regional liver volume are significantly associated with increased risk for intra‒hepatic bile duct cancer, and hepatic resection is recommended. Recent progress in the use of endoscopic interventions has enabled endoscopic lithotomy of intra‒hepatic biliary stones. However the procedure leaves a stricture in the biliary tree that increases the risk for another biliary stone or malignancy development ; therefore, intensive surveillance is recommended after the procedure. The incidence and mortality rate of biliary malignancy has increased recently. Therefore, there is a need to develop surveillance and preemptive therapy for high‒risk patients, as well as to address the mechanism of biliary carcinogenesis. |
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