Opisthorchiasis and Cholangiocarcinoma in the Northeast Thailand : Treatment by Surgery

Abstract

Abstract
An estimation as high as 70% of the population in certain region of the Northeast Thailand is infected with Opisthorchis viverrini and the incidence of cholangiocarcinoma among this population may be 50 times higher than in Western countries.
Epidemiological and experimental studies suggested that dietary contamination with carcinogen may be the essential causative factor : synergistic effects of nitrosamines and Opisthorchis inducing cholangiocarcinoma was found experimentally in Syrian golden hamster.
The peak age of presentation Opisthorchiasis infestation and cholangiocarcinoma for surgical management is between 45 and 65 years males : females with a ratio of 4:5:1.  There are two forms of presentation :the jaundiced (central) 60% and the non-jaundiced (peripheral) 40%.  The pathological findings at operation are usually very advanced stage of Opisthorchiasis or cholangiocarcinoma.
The surgical procedures are dictated by the pathology found at operation which include tumour excision and reconstruction of enterobiliary continuity, bypass procedure for jaundiced patients; and hepatectomy to remove the diseased lobe in the non-jaundiced.
On the whole, results of treatment for non-jaundiced patients are far better than these who ae jaundiced.  Among the jaundiced patients, the perioperative mortality rate is 15-20% and the survival rates at 3-month, 1-year and 5-year are 50%, 15% and 1 to 2%, respectively.  In the non-jaundiced, the perioperative death of hepatectomy is less than 2%, one year survival 75%, two years survival 50% and five years survival 15%