Cholangiocarcinoma in choledochal cyst after cystoenterostomy: how a mistreated choledochal cyst can progress to malignancy

Baik, HyungJoo; Park, Yo-Han; Seo, Sang Hyuk; An, Min Sung; Kim, Kwang Hee; Bae, Ki Beom; Choi, Chang Soo; Oh, Sang Hoon; Choi, Young Kil

doi:10.14701/ahbps.2016.20.4.201

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…Cystoenterostomy has been abandoned due to reports of a higher malignant potential compared with complete cyst resection. [44][45][46] In 1980, Yamaguchi recommended the total excision for the prevention of ascending cholangitis, cystolithiasis, and malignant transformation following an analysis of 1.433 patients from the Japanese literature, and Lilly reported on the superiority of total cyst excision due to simultaneous treatment of coexisting biliary malformations. 47,48 Additionally, according to Filler and Stringel, total excision should be preferred for the elimination of bile stasis, prevention of chronic pancreatic reflux into the cyst, and the prevention of cancer.…”

Section: Operation Methodsmentioning

confidence: 99%

Choledochal Cyst and Malignancy: A Plea for Lifelong Follow-Up

et al. 2017

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Previous research has confirmed that patients with choledochal cyst have an elevated risk of cholangiocarcinoma and gallbladder carcinoma. Current data suggest a risk of malignancy of 6 to 30% in adults with choledochal cyst. Malignancy has also occasionally been identified in children and adolescents. Multiple factors, including the age of the patient, cyst type, histological findings, and localization, have an impact on the prognosis. Information on long-term outcomes after cyst excision is limited. However, recent data suggest a lifelong elevated risk of up to 4% of cancer development following operation. This paper presents a review of the literature on cancer in patients with choledochal cyst before and after excision. A postoperative follow-up concept that consists of annual controls of CA19-9 and abdominal ultrasound is introduced.

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Section: Operation Methodsmentioning

confidence: 99%

Choledochal Cyst and Malignancy: A Plea for Lifelong Follow-Up

et al. 2017

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“…The earlier drainage procedures have been long abandoned due to the high rate of malignancies that ensue, especially when internal drainage operations are used. It has been reported that patients who have had previous internal drainage operations developed malignancies at relatively young ages (32,33), a circumstance in which enterokinase was implicated. It has been postulated that the enterokinase enhances the activation of refluxed pancreatic enzymes, consequently accelerating the destruction of biliary epithelium (34).…”

Section: Discussionmentioning

confidence: 99%

Establishment and validation of a predictive nomogram for the risk of premalignant lesions in children with choledochal cyst

Gao

Shi

et al. 2023

Front. Pediatr.

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BackgroundCholedochal cyst (CDC) increases the risk (2.5%–30%) of malignancy. Metaplasia and dysplasia have been recognized as premalignant lesions among CDCs. This study aimed to evaluate the risk factors of metaplasia and dysplasia in CDC children.MethodsTwo hundred and ten CDC children who underwent cyst excision and Roux-en-Y hepaticojejunostomy at our institution between July 2020 and November 2021 were included and randomly divided into the training set and validation set. Univariate and multivariate logistic regression analysis were used to identify independent risk factors of premalignant lesions in the training set and build a predictive nomogram. The performance and discriminatory abilities of the nomogram were further assessed and validated in the validation set.ResultsOf the 210 CDC children, 78 (37.1%) patients developed premalignant lesions. Age (OR, 1.011, 95%CI, 1.000–1.022, P = 0.046), symptoms duration (OR, 1.021, 95%CI, 1.001–1.042, P = 0.036), cyst diameter (OR, 1.737, 95%CI, 1.328–2.273, P < 0.001), recurrent attacks of biliary pancreatitis (OR, 3.653, 95%CI, 1.205–11.076, P = 0.022), and biliary operation history (OR, 5.860, 95%CI, 1.268–27.084, P = 0.024) were identified as independent risk factors. Based on these predictors, a predictive nomogram was generated. The AUC of the nomogram was 0.873 in the training set and 0.793 in the validation set, indicating that it was robust and well calibrated.ConclusionsA novel nomogram to the individualized risk of premalignant lesions in CDC children was successfully built, on the basis of age, symptoms duration, cyst diameter, recurrent attacks of biliary pancreatitis, and biliary operation history. This nomogram, combined with the final pathological results, can help clinicians to develop more efficient follow-up strategies for the high-risk children with CDC.

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“…Namun, risiko terjadinya karsinoma saluran bilier setelah pasien CC menjalani reseksi berkisar antara 0.7-6%. [7,8] Pasien CC yang ditangani sampai usia 10 tahunmemiliki risiko terjadi karsinoma saluran bilier sebesar 0,7%, antara usia 10-20 tahun sebesar 6,8% dan usia lebih 20 tahun sebesar 14,3%. Patogenesis terjadinya keganasan saluran bilier diperkirakan karena refluks cairan pankreas ke saluran bilier sehingga epitel saluran bilier mengalami inflamasi kronis dan perubahan ke arah keganasan.…”

Section: Pendahuluanunclassified

Choledochal Cyst: Serial Kasus

Yudadi¹,

Diarsvitri²

2021

SBJ

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Penelitian ini bertujuan untuk melaporkan diagnosis dan manajemen dari beberapa kasus langka choledochal cyst (CC), kelainan kongenital saluran bilier yang ditangani di Sub Departemen Bedah Digestif RSPAL Dr. Ramelan, Surabaya. Artikel ini disusun berdasarkan laporan tiga serial kasus CC yang ditangani di Sub Departmen Bedah Digestif RSPAL dr. Ramelan tahun 2018-2020. Dilaporkan tiga kasus CC pada pasien perempuan: dua kasus pada pasien berusia 20 tahun, dan satu kasus pada pasien berusia 64 tahun. Pada ketiga pasien tersebut ditemukan gejala berupa nyeri abdomen di daerah epigastrium, dua orang dengan ikterus intermiten dan seorang pasien dengan kondisi situs inversus. Hanya seorang pasien teraba massa di daerah epigastrium. Pada pemeriksaan penunjang dengan USG abdomen, MRCP dan cholangiografi intraoperatif ditemukan gambaran dilatasi kistik choledocus (common bile duct) yang mendukung suatu CC, dan tidak tampak batu di saluran bilier. Pada saat operasi, pada ketiga pasien tersebut ditemukan CC tipe I (klasifikasi Todani tipe I) dengan bentuk fusiformis. Diputuskan dilakukan eksisi CC dan rekonstruksi biliodigestif dengan hepatikojejunostomi Roux-en-Y. Hasil pemeriksaan patologi anatomi menunjukkan tanda radang dinding saluran bilier dan tidak ditemukan tanda keganasan. Pasca operasi, kondisi ketiga pasien tersebut baik. CC pada pasien dewasa sering ditemukan dengan gejala yang tidak jelas dan disertai komplikasi. Manajemen CC dengan eksisi dan rekonstruksi biliodigestif hepatikojejunostomi Roux-en-Y berhasil dengan baik.

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Cholangiocarcinoma in choledochal cyst after cystoenterostomy: how a mistreated choledochal cyst can progress to malignancy

Cited by 6 publications

References 8 publications

Choledochal Cyst and Malignancy: A Plea for Lifelong Follow-Up

Choledochal Cyst and Malignancy: A Plea for Lifelong Follow-Up

Establishment and validation of a predictive nomogram for the risk of premalignant lesions in children with choledochal cyst

Choledochal Cyst: Serial Kasus

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