Bile duct cancer developed after cyst excision for choledochal cyst

Abstract

Oncogenesis after cyst excision for choledochal cyst and suitable surgical procedures for this operation are discussed. The clinical data of 23 patients with cancer of the biliary tree after excision of choledochal cyst reported in the English-language and Japanese literature were reviewed, and data for 1353 Japanese patients with choledochal cyst and/or pancreaticobiliary malunion were analyzed. In the 23 patients reported in the literature, age at cyst excision ranged from 1 to 55 years (average, 23.0 +/- 13.7 years), and cancers were detected at age 18-60 years (average, 32.1 +/- 12.2 years), with intervals between cyst excision and cancer detection of 1-19 years (average, 9.0 +/- 5.5 years). Sites of cancer development were: intrahepatic, six; anastomotic, eight; hepatic side residual cyst, three; and the intrapancreatic duct, six. In the Japanese patients with choledochal cyst and/or pancreaticobiliary malunion, the incidence of cancer associated with primary choledochal cyst and/or pancreaticobiliary malunion was 16.2% (219/1353). The incidence of cancer development after cyst excision in this population, of whom 1291/1353 underwent surgery, was assumed to be 0. 7%. Nearly half of the 23 patients in the literature had undergone inadequate cyst excision. Oncogenesis of cancers after cyst excision is possibly different from that of choledochal cysts.

Choledochal Cyst: Their clinical presentation, diagnosis and treatment in central Nepal: a retrospective study

“…Choledochal cyst associated cholangiocarcinoma following complete cyst excision with cholecystectomy followed by biliary drainage are generally found in 11% of cases. [36][37][38] It was not found in any of our patients. This may be due to the fact that the risk of associated Original Research Article cholangiocarcinoma increases with age, and the average age of our patients was 10 years.…”

Chemopreventative Effect of Hochu-ekki-to (TJ-41) on Chemically Induced Biliary Carcinogenesis in Hamsters

“…Reflux cholangitis (1-3), biliary stones (3,4), and liver abscess (2) are the well-known complications after bilioenterostomy. Recently, clinical studies have revealed that biliary carcinomas can occur as a delayed complication of bilioenterostomy for benign disease (5)(6)(7)(8), and we have demonstrated that persistent reflux cholangitis after bilioenterostomy accelerates biliary carcinogenesis through an activation of biliary epithelial cell kinetics in hamsters (9,10).…”

Choledochal Cyst: A Report of 3 Cases and a Review of its Treatment and Outcome

“…There is immediate relief of symptoms with either of these technique, but the risk of complications and malignancy in the residual cyst can be high, as high as 2.5-26% [50,51]. Anastomotic site stricture, formation of bile stones, tendency for recurrent cholangitis due to bile stasis are commonly associated internal drainage procedures [52]. Nevertheless, internal or external drainage is still a useful palliative emergency procedure in unstable patients with cholangitis, perforation of the cyst or malnutrition pending a definitive procedure (cyst excision) [53,54].…”