Anomalous union of the pancreaticobiliary duct without choledochal cyst: is cholecystectomy alone sufficient?

Kim, Yeji; Hyun, Jong Jin; Lee, Jae Min; Lee, Hong Sik; Kim, Chang Duck

doi:10.1007/s00423-014-1223-5

Cited by 12 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence of malignancy was 7·3 per cent among patients with choledochal malformation and the rate of malignant transformation was 3·4 per cent. This finding implies that treating choledochal malformation may reduce the risk of developing malignancy, and is consistent with the commonly accepted theory that carcinogenesis might be related to dysplasia and metaplasia of the epithelium of the choledochal malformation. Complete cyst excision followed by construction of a bilioenteric anastomosis is therefore believed to protect the patient from developing malignancy.…”

Section: Discussionsupporting

confidence: 86%

“…It could be speculated that prolonged reflux of pancreatic secretions into the biliary tract occurs in Todani types I and IV, which frequently present with abnormal pancreaticobiliary duct junctions. Prolonged reflux might lead to malignant degeneration of the biliary epithelium. The situation is supposedly different in types II and III choledochal malformations, which might be true congenital malformations in which reflux is absent.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of risk of developing malignancy in congenital choledochal malformation

Hove

Meijer

Hulscher

et al. 2018

British Journal of Surgery

View full text Add to dashboard Cite

BackgroundCholedochal malformations comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. Choledochal malformation is generally considered a premalignant condition, but reliable data on the risk of malignancy and optimal surgical treatment are lacking. The objective of this systematic review was to assess the prevalence of malignancy in patients with choledochal malformation and to differentiate between subtypes. In addition, the risk of malignancy following cystic drainage versus complete cyst excision was assessed.MethodsA systematic review of PubMed and Embase databases was performed in accordance with the PRISMA statement. A meta‐analysis of the risk of malignancy following cystic drainage versus complete cyst excision was undertaken in line with MOOSE guidelines. Prevalence of malignancy was defined as the rate of biliary cancer before resection, and malignant transformation as new‐onset biliary cancer after surgery.ResultsEighteen observational studies were included, reporting a total of 2904 patients with a median age of 36 years. Of these, 312 in total developed a malignancy (10·7 per cent); the prevalence of malignancy was 7·3 per cent and the rate of malignant transformation was 3·4 per cent. Patients with types I and IV choledochal malformation had an increased risk of malignancy (P = 0·016). Patients who underwent cystic drainage had an increased risk of developing biliary malignancy compared with those who had complete cyst excision, with an odds ratio of 3·97 (95 per cent c.i. 2·40 to 6·55).ConclusionThe risk of developing malignancy among patients with choledochal malformation was almost 11 per cent. The malignancy risk following cystic drainage surgery was four times higher than that after complete cyst excision. Complete surgical resection is recommended in patients with choledochal malformation.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Meta-analysis of risk of developing malignancy in congenital choledochal malformation

Hove

Meijer

Hulscher

et al. 2018

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Some investigators recommended removal of the extrahepatic bile duct along with the gallbladder to prevent cancer development in the remnant nondilated bile duct. 3 , 16 According to a study by Kim et al, 10 of 55 patients with AUPBD, conducted to evaluate the occurrence of biliary tract cancer, ECC occurred more frequently in patients without bile duct dilatation than in those with bile duct dilatation (30.0% vs 4.0%; P = 0.015). They recommended extrahepatic bile duct excision, biloenteric anastomosis, and cholecystectomy as a treatment of choice for AUPBD without bile duct dilatation; however, routine excision of the extrahepatic bile duct in AUPBD patients presents the risk of postoperative adverse events in 9.7% to 20% of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…Although controversy remains regarding the mechanism of carcinogenesis, many studies demonstrated that biliary tract cancers develop preferentially at sites where there is stasis of activated pancreatic enzymes, such as in the dilated bile duct or gallbladder. 10 In this regard, prophylactic flow-diversion surgery consisting of extrahepatic bile duct resection along with cholecystectomy is widely accepted as the treatment of choice for AUPBD patients with bile duct dilatation to prevent development of both bile duct and gallbladder cancer. 11 For AUPBD without bile duct dilatation, prophylactic cholecystectomy alone is generally performed and advocated in many institutions owing to the concept that the stasis of pancreatic enzymes occurs mainly in the gallbladder 5 ; however, some experts suggest excision of the extrahepatic biliary tract and cholecystectomy in AUPBD patients without biliary dilatation because reflux of pancreatic enzyme would still occur after cholecystectomy, thereby predisposing the patient to other biliary tract cancers.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors of Biliary Tract Cancer in Anomalous Union of the Pancreaticobiliary Duct

et al. 2016

View full text Add to dashboard Cite

The assessment of malignancies associated with anomalous union of the pancreaticobiliary duct (AUPBD) is essential for the design of appropriate treatment strategies. The aim of the present study is to measure the incidence of AUPBD-related pancreaticobiliary malignancy and to identify predictive factors. This retrospective cohort study included cases of 229 patients with AUPBD between January 1999 and December 2013. The impact of bile duct dilatation on the incidence of AUPBD-related pancreaticobiliary disease was measured, and predictive factors were evaluated.Among 229 patients with AUPBD, 152 had common bile duct dilatation (≥10 mm) (dilated group) and 77 did not (<10 mm) (nondilated group). Intrahepatic cholangiocarcinoma occurred more frequently in the nondilated group than in the dilated group (3.9% vs 0%; P < 0.05). By contrast, no significant difference in the incidence of extrahepatic cholangiocarcinoma was observed between the 2 groups (1.3% vs 3.9%; P = 0.271). By univariate analysis, age, type of AUPBD, and the level of pancreatic enzymes refluxed in the bile duct were associated with occurrence of biliary tract cancers. In multivariate analysis, age ≥45 years (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.011–1.073, P < 0.05), P-C type (OR 3.327, 95% CI 1.031–10.740, P < 0.05), and a high level of biliary lipase (OR 4.132, 95% CI 1.420–12.021, P < 0.05) showed a significant association with AUPBD-related biliary tract cancer.Intrahepatic cholangiocarcinoma may occur more frequently in AUPBD patients without bile duct dilatation. Age ≥45 years, P-C type, and biliary lipase level ≥45,000 IU/L are significantly associated with AUPBD-related biliary tract cancer.

show abstract

“…For the rarest CM subtypes -common bile duct diverticula and choledochocele -with a low risk for malignant transformation, simple surgical excision or endoscopic discision are considered adequate approaches (11,14). Whether an isolated PBM without proximal dilatation warrants removal of the extrahepatic biliary tree or could be managed by cholecystectomy alone to decrease the risk for subsequent gallbladder cancer remains controversial (15,16).…”

mentioning

confidence: 99%

Management strategies and treatment results of pediatric choledochal malformations in the Nordic countries

Hukkinen¹,

Björnland

Gatzinsky

et al. 2020

HPB

View full text Add to dashboard Cite

Background. Incidence and long-term outcomes of choledochal malformations (CMs) in children remain unclear. Methods. Clinical characteristics, operative details, complications, and follow-up data were collected from eight pediatric surgical centers in Sweden, Norway, Denmark, and Finland, which also answered a questionnaire addressing management practices. Results. During 2000-2017, 126 pediatric CMs were diagnosed, corresponding an incidence of 1:37,400. Diagnostic, treatment, and follow-up practices varied markedly. Of patients with complete clinical data (n=119), 85% and 11% had type I and IV CMs and were managed by open hepaticojejunostomy at median age of 2.5 (interquartile range 0.46-5.8) years. Associated malformations were more common in fusiform and type IV (23%) than cystic CMs (8%, p=0.043). Pancreaticobiliary maljunction was more frequently confirmed in patients presenting with pancreatitis (26% vs. 7%, p=0.005) and with fusiform CMs (56% vs. 25%, p=0.001). Cholangitis/pancreatitis episodes, occurring in 12% during postoperative follow-up of 4.0 (2.0-7.9) years, associated with longer surveillance (OR 1.32, 95% CI 1.13-1.54, p<0.001). However, only two thirds of centers continued follow-up until adulthood. No malignancies were reported. Conclusions. CM incidence was higher than traditionally reported among Western populations. Although open hepaticojejunostomy carries good short-term outcomes, long-term morbidity is noteworthy. Standardized evidence-based management strategies and long-term follow-up are encouraged.

show abstract

Anomalous union of the pancreaticobiliary duct without choledochal cyst: is cholecystectomy alone sufficient?

Abstract: Since cancers of the biliary tract occur more frequently in the AUPBD group without choledochal cyst,cholecystectomy alone may not be protective of the future occurrence of bile duct cancers, and thus, vigilant surveillance is necessary in this population group.

Cited by 12 publications

References 17 publications

Meta-analysis of risk of developing malignancy in congenital choledochal malformation

Meta-analysis of risk of developing malignancy in congenital choledochal malformation

Predictive Factors of Biliary Tract Cancer in Anomalous Union of the Pancreaticobiliary Duct

Management strategies and treatment results of pediatric choledochal malformations in the Nordic countries

Contact Info

Product

Resources

About