Clinical characteristics of patients with malignancy and long-term outcomes of surgical treatment of patients with choledochal cyst

Abstract

Purpose There are few reports of postoperative long-term malignant risk or postoperative sequelae after surgery for choledochal cysts (CCs). This study aimed to analyze the clinical characteristics of patients with malignancy and the long-term results of operated CC. Methods The patients who underwent surgical treatments for CC between 2003 and 2020 at Seoul National University Hospital were enrolled. Clinicopathologic factors and pre-/postoperative computed tomography or magnetic resonance imaging were reviewed. Results Of the 153 patients, Todani classification Ic (36.6%), C-P type (43.8%) anomalous pancreaticobiliary duct union were the most common type respectively. Fourteen patients (9.2%) had biliary tract cancer and a comparison of patients with and without malignancy showed that the diameter of cyst was significantly lower in malignant patients and malignancy was observed to be significantly higher in P-C type. The incidence of long-term complications was 9.8%, and the median time interval was 30 months. The 2 most common complications were cholangitis and stricture (60.0%). There was one case of new cancer near the intrapancreatic remnant bile duct. Conclusion Of the resected CCs, 9.2% had a combined malignancy on the biliary tracts. Long-term complications such as cholangitis, anastomotic stricture, and new cancers may occur. Therefore, continuous surveillance is required.

The Curious Case of the Choledochal Cyst—Revisiting the Todani Classification: Case Report and Review of the Literature

“…Unfortunately, despite radical treatment, early postoperative complications can occur and include ileus, bile leakage, pancreatitis, and pancreatic fistula. Late complications are rare, but tedious and multiple issues have been reported, from incisional hernias to biliary stricture, choledocholithiasis, and recurrent cholangitis, while between 0.7 and 10% of patients develop cholangiocarcinoma or pancreatic adenocarcinoma after surgery at variable intervals, even after several decades [ 10 , 13 , 50 , 51 , 52 ]. The largest retrospective study published so far reports on the long-term follow-up of 3911 patients who underwent CC resections, and the authors propose a life-long evaluation of patients, with an increase in the frequency of liver function tests and ultrasound assessments after the first 20 years following the initial resection [ 53 ].…”

“…Types IA, IC, and IVA are usually associated with a pancreaticobiliary maljunction [ 12 ]. Types I and IV have been repeatedly cited in both case reports and systematic reviews as having the highest potential for long-term postoperative complications, including intrahepatic bile duct dilatation, the development of intrahepatic calculi, cholangitis, strictures, and metachronous malignancy [ 10 , 13 , 14 ].…”