What is the Incidence of Biliary Carcinoma in Choledochal Cysts, When Do They Develop, and How Should it Affect Management?

Sastry, Amit; Abbadessa, Benjamin; Wayne, Michael; Steele, Justin; Cooperman, Avram M.

doi:10.1007/s00268-014-2831-5

Cited by 94 publications

(74 citation statements)

References 107 publications

(303 reference statements)

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“…Cholangio carcinoma is the most common malignancy associated with CDC and up to 35% occurrence has been reported in Japanese and Korean studies. 15,37,38 In our series, only 20% (n=12/60) patients had APBDJ and also the association with biliary malignancy was quite low. This lends credence to hypothesis of causal relationship between APBDJ and biliary tract carcinomas.…”

Section: Discussioncontrasting

confidence: 54%

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Kumar¹

2018

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Background: Aim of the study was to analyze the clinicopathological profile and long-term operative outcomes of patients with choledochal cysts (CDC) undergoing cyst excision. Methods: Clinical data of 73 adult CDC patients managed at a single tertiary care center between January 2010 and December 2016 were retrospectively analyzed. Patients who had undergone complete cyst excision and with a minimum follow-up of 12 months were included for long-term outcome analysis. Results: The male female ratio was approximately 1:3 and the median age was 35 years (range, 12-65 years). Type I CDC was the most common cyst type in this series (n=49/73, 67.1%). Abdominal pain was the commonest presenting symptom followed by jaundice, fever and palpable lump. Coexisting gallbladder carcinoma was encountered in 4/73 (5.48%) patients while two patients had secondary biliary cirrhosis with portal hypertension. Complete cyst excision was performed in 65 out of 73(89.0%) patients. Patients undergoing complete cyst excision were followed-up for a median duration of 29.5 months (range, 12-70 months). One case of hepaticojejunostomy stricture and two cases of post-operative incisional hernia were reported. No new case of cholangiocarcinoma was reported in any of our patients. Conclusion: Adulthood CDC are associated with an increased incidence of complications like recurrent cholangitis, pancreatitis and cyst perforation. The lesser association of biliary tract malignancy in Indian population may possibly be linked to a lower incidence of abnormal pancreaticobiliary duct junction. Complete cyst excision with hepaticojejunostomy remains the standard treatment both to relieve the symptoms and to minimize the risk of malignancy.

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Section: Discussioncontrasting

confidence: 54%

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Kumar¹

2018

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“…Intraoperative cholangiography can be performed to confirm the clearance. Intrapancreatic cyst remnant is a significant risk factor for pancreatic carcinoma [19–21]. Thus, radical excision of the residual cyst is strongly advocated.…”

Section: Discussionmentioning

confidence: 99%

Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts: Our Experience in 18 Cases

Sheng

et al. 2017

Med Sci Monit

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BackgroundComplete cyst excision with biliary reconstruction is the treatment of choice for choledochal cyst (CC). The aim of this article is to review our experience in patients who underwent reoperation between January 1995 and December 2014.Material/MethodsThe records of 18 patients (female/male, 15/3) were retrospectively analyzed including age, sex, cyst type, initial procedure, lab and imaging findings, indications for reoperation, intraoperative findings, and results of reoperation. The median follow-up period was 6 years.ResultsThe rate of reoperation in this study was about 6.8%. Eighteen patients (7 type Ia, 2Ic, 9 IV-A) developed severe postoperative complications and required surgical intervention. The median time interval from primary surgery to reoperation was 19.5 months (range, 3 days to 8 years). Two early complications required surgery due to anastomotic bile leakage and intussusception. Sixteen late complications occurred, including 3 intrahepatic bile duct stenosis with calculi, 5 anastomotic strictures with/without stones, 4 intrapancreatic cyst remnants, 3 adhesive bowel obstructions, and 1 internal hernia. For patients with persistent dilatation of the intrahepatic bile duct or anastomotic stricture, removal of stones and revision of hepaticojejunostomy were performed, with additional hepatic ductoplasty when necessary. Radical excision of the dilated cystic remnant in the head of pancreas was performed in 4 patients, with 1 needing additional pancreaticojejunostomy procedure. No deaths occurred. Sixteen patients recovered uneventfully after reoperation, and 2 wound infections developed.ConclusionsA wide hepaticojejunostomy with/without ductoplasty is essential to prevent cholangitis, anastomotic stricture, and calculi formation. Complete cyst excision, including the intrapancreatic portion, should be meticulously pursued.

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“…Bile duct cysts are a rare congenital disorder characterized by cystic dilatation of the intrahepatic and/or extrahepatic biliary tree; according to the classification, they can be divided into type I, type II, type III, type IV and type V (Table ) . The frequency of bile duct cysts is high in females of Asian countries, especially China and Japan, while is relatively low in Western populations . The association between bile duct cysts and CCA is well established and, when they are undetected or treated inappropriately, tumour can arise from both cysts and undilated parts of the biliary tree .…”

Section: Risk Factorsmentioning

confidence: 99%

Cholangiocarcinoma: Epidemiology and risk factors

Khan

Tavolari

Brandi

2019

Liver International

499

495

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Cholangiocarcinoma (CCA) is a heterogeneous disease arising from a complex interaction between host‐specific genetic background and multiple risk factors. Globally, CCA incidence rates exhibit geographical variation, with much higher incidence in parts of the Eastern world compared to the West. These differences are likely to reflect differences in geographical risk factors as well as genetic determinants. Of note, over the past few decades, the incidence rates of CCA appear to change and subtypes of CCA appear to show distinct epidemiological trends. These trends need to be interpreted with caution given the issues of diagnosis, recording and coding of subtypes of CCA. Epidemiological evidences suggest that in general population some risk factors are less frequent but associated with a higher CCA risk, while others are more common but associated with a lower risk. Moreover, while some risk factors are shared by intrahepatic and both extrahepatic forms, others seem more specific for one of the two forms. Currently some pathological conditions have been clearly associated with CCA development, and other conditions are emerging; however, while their impact in increasing CCA risk as single etiological factors has been provided in many studies, less is known when two or more risk factors co‐occur in the same patient. Moreover, despite the advancements in the knowledge of CCA aetiology, in Western countries about 50% of cases are still diagnosed without any identifiable risk factor. It is therefore conceivable that other still undefined etiologic factors are responsible for the recent increase of CCA (especially iCCA) incidence worldwide.

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What is the Incidence of Biliary Carcinoma in Choledochal Cysts, When Do They Develop, and How Should it Affect Management?

Cited by 94 publications

References 107 publications

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts: Our Experience in 18 Cases

Cholangiocarcinoma: Epidemiology and risk factors

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