Ann Surg Treat Res.  2021 Dec;101(6):332-339. 10.4174/astr.2021.101.6.332.

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

Affiliations
  • 1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

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 longterm 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.

Keyword

Biliary tract; Choledochal cyst; Neoplasms

Figure

  • Fig. 1 Laparoscopic surgery began in the early 2000s, but open surgery was dominant until 2013. Nonetheless, robotic surgery was performed after that, and only robotic and laparoscopic surgeries were performed in 2018–2019.

  • Fig. 2 Delayed complications are observed in 15 patients (9.8%), cholangitis in 9 patients (60.0%), ileus in 2 patients (13.3%), liver abscess in 2 patients (13.3%), pancreatitis in 1 patient (6.7%), and cyst infection in 1 patient (6.7%). The patients with acute complications are marked with slashes. The complication timing range is 3–159 months, and the median is 30.0 months. One patient developed a new cancer around the distal remnant cyst. The patient had pancreatic head cancer 39 months later.


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