Surgical strategy for mucin‐producing bile duct tumor

Abstract

Tumors with copious mucin production within the intra‐ or extrahepatic bile ducts have been reported as mucin‐producing bile duct tumors (MPBTs). Because mucin produced by these tumors causes recurrent cholangitis and obstructive jaundice, surgical resection should be indicated even if these tumors are regarded as benign. In order to choose the appropriate surgical procedure, exact preoperative assessment of tumor location and cancer extension is important, especially evaluation of the extent of superficial spreading through cholangioscopic observation and biopsy. In principle, MPBTs should be resected in a manner similar to that employed for other types of bile duct carcinomas. That is, major hepatectomy with or without extrahepatic bile duct resection or pancreaticoduodenectomy should be chosen as the surgical procedure, and intraoperative frozen section at the stumps of the bile duct is essential. On the other hand, when precise diagnosis is completed preoperatively and the lesion is diagnosed as adenoma or carcinoma with invasion confined to the ductal wall and limited superficial spreading, limited resections preserving organ functions as much as possible can be considered as a choice among surgical procedures. All ten patients with MPBT resected at our institution according to these strategies are still alive without tumor recurrence, with a median survival of 48.0 months.

Intraductal Papillary Neoplasms of the Bile Duct

“…On the other hand, in cases of IPNB with low- to high-grade intraepithelial neoplasia and limited superficial spreading and precise diagnosis which is completed preoperatively, limited resections preserving organ functions, for example, extensive hilar bile duct resection using a transhepatic approach [28, 29], can be considered as a choice among surgical procedures, although these should always be contingent on a careful intraoperative final assessment. In contrast, in cases of IPNB with extensive superficial spreading that may have positive margins or IPNB with multifocal involvement, tumor recurrence may occur with a high risk after surgical resection.…”

The Outcome of Ipsilateral Hemihepatectomy in Mucin-Producing Bile Duct Tumors

“…However, an appropriate surgical strategy has not ever been documented, partly because MPBTs are uncommon. There have been a few reports in literature providing details on patients with MPBTs [1], [10]. We analyzed the clinical records of 9 patients with MPBTs who underwent ipsilateral hemihepatectomy, and reported our findings here.…”

“…MPBTs are rare bile duct tumors that secrete clinically detectable mucin into bile duct [1]. The common presentation is obstructive jaundice and cholangitis secondary to biliary obstruction by mucin [2], [3], [10].…”

“…However, some tumors produce copious mucin within the intra- or extrahepatic bile ducts, resulting in obstructive jaundice and cholangitis, as well as marked dilatation of bile ducts. These tumors have been reported as mucin-producing bile duct tumors [1].…”

“…Because of unaccurately preoperative diagnosis, surgeron usually failed to determine the initiation site of tumor, as well as the tumor invasion range in superficial mucosal layer. Such delay of definitive diagnosis and receiving biliary surgery without curative resection of primary lesion would make patients' prognosis poor and add patients' financial burden [1].…”