Dysplasia of Cystic Duct and Positive Resection Margins after Cholecystectomy: A Challenging Decision Making Process

Cianfarani, Agnese; Mongelli, Francesco; Giuseppe, Matteo Di; Regina, Davide La

doi:10.29011/2575-9760.001195

Cited by 3 publications

(4 citation statements)

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“…Finally, three studies were found eligible and considered in this systematic review. [10][11][12] The characteristics of the included studies are given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…11 More recently, Cianfarani et al reported a case of positive resection margins for lowgrade dysplasia on the cystic duct that was successfully surgical treated with a cystic stump resection. 12 The lack of literature about the surveillance of cystic duct dysplasia makes difficult to draw conclusions. A possible management algorithm is shown in Figure 2.…”

Section: Figure 3: Histologic Exam Showing a Low-grade Dysplasia On Tmentioning

confidence: 99%

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Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Mongelli¹,

Cianfarani²,

Giuseppe³

et al. 2019

Int Surg J

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In this article, we discuss the matter and suggest a possible management algorithm. METHODS Search strategyTwo researchers independently searched the PubMed, Cochrane Library and Google Scholar databases by combining "cholecystectomy" and "dysplasia" and ABSTRACT Approximately 1 to 3.5% of cholecystectomies are found to have incidental dysplasia on histological examination. Cases of positive resection margins on the cystic stump are rare and evidence lack. The aim of this article was to systematically review the literature and to suggest a possible management algorithm. We searched PubMed, Cochrane Library and Google Scholar databases by combining "cholecystectomy" and "dysplasia" and "cystic" according to preferred reporting items for systematic reviews and meta-analyses guidelines. Studies providing information about cystic duct dysplasia with positive resection margin after cholecystectomy were included. We identified 113 articles, of which three were considered eligible. Five patients had a high-grade dysplasia, one patient had a carcinoma and one had a low-grade dysplasia. Median follow-up was of 10.5 months (range: 0.5-26.6 months), no evidence of recurrence was found in patients with dysplasia, while the patient with diagnosis of cholangiocarcinoma died during follow-up. Patients with positive resection margins for dysplasia after cholecystectomy should be considered for a surgical treatment according to clinical and pathological factors. Simple cystic duct stump excision was suggested and seems to be safe and effective with no evidence of recurrence during follow-up when a R0 resection is achieved. A multidisciplinary approach and a surveillance program should be always taken into account.

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“…Finally, three studies were found eligible and considered in this systematic review. [10][11][12] The characteristics of the included studies are given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Figure 3: Histologic Exam Showing a Low-grade Dysplasia On Tmentioning

confidence: 99%

Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Mongelli¹,

Cianfarani²,

Giuseppe³

et al. 2019

Int Surg J

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“…Nine studies were excluded because did not match inclusion and exclusion criteria. Finally, three studies were found eligible and considered in this systematic review [10][11][12] (Figure 1). The characteristics of the included studies are given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Mongelli

Cianfarani

Giuseppe

et al. 2019

Preprint

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Purpose Approximately 1 to 3.5% of cholecystectomies are found to have incidental dysplasia on histological examination. Cases of positive resection margins on the cystic stump are rare and evidence lack. The aim of this article was to systematically review the literature and to suggest a possible management algorithm. Methods We searched PubMed, Cochrane Library and Google Scholar databases by combining “cholecystectomy” AND “dysplasia” AND “cystic” according to PRISMA guidelines. Studies providing information about cystic duct dysplasia with positive resection margin after cholecystectomy were included. Results The searches identified 109 articles from PubMed and 4 articles from Cochrane Library and Google Scholar, of which three were eligible. Five were found to have post-operative high-grade dysplasia, one patient had a carcinoma and one had a low-grade dysplasia. Median follow-up was of 10.5 months (range: 0.5 – 26.6 months), no evidence of recurrence was found in patients with dysplasia, while the patient with diagnosis of cholangiocarcinoma died during follow-up. Conclusions Patients with positive resection margins for dysplasia after cholecystectomy should be considered for a surgical treatment. The latter depends on several factors related to the patient and the grade of dysplasia itself. Simple cystic duct stump excision has been suggested and it seems to be safe and effective with no evidence of recurrence during follow-up when a R0 resection is achieved. A multidisciplinary approach and a surveillance program should be always taken into account.

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“…The authors of the most recent case report pursued a cystic duct stump excision in light of prior findings of malignancy associated with high-grade cystic duct dysplasia. They however did not offer surveillance after excision [ 16 ]. Similarly, we pursued a laparoscopic cystic duct stump excision, without offering further surveillance or malignancy workup due to normal labs and the patient's excellent postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

Case and Management Considerations of Low-Grade Cystic Duct Stump Dysplasia after Laparoscopic Cholecystectomy

Ufongene,

Kunaprayoon,

Mestre

2024

Case Reports in Surgery

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Cholecystectomies have become one of the more commonly practiced procedures. As a result, there has been a rise in neoplastic changes in excised specimens. Due to this, surgeons must be prepared to manage possible malignancy after resecting what was previously thought to be a benign gallbladder. While management for high-grade dysplasia has been more clearly laid out in literature, data on management of low-grade dysplasia are limited. Here, we report a novel case of a 46-year-old woman with an incidental low-grade dysplasia of the cystic duct stump after a laparoscopic cholecystectomy for biliary colic. The decision was made to excise the remaining stump without further surveillance postoperatively given benign pathology findings. More documented cases and their management and ultimately longitudinal cohort studies will help facilitate the creation of guidelines for managing this particular pathology.

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Dysplasia of Cystic Duct and Positive Resection Margins after Cholecystectomy: A Challenging Decision Making Process

Cited by 3 publications

References 0 publications

Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Case and Management Considerations of Low-Grade Cystic Duct Stump Dysplasia after Laparoscopic Cholecystectomy

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