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Choledochal cysts in adults.
Chi-Leung Liu1, Sheung-Tat Fan, Chung-Mau Lo
1Centre for Liver Disease, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong. clliu@hkucc.hku.hk
Archives of Surgery (Chicago, Ill. : 1960)
|April 3, 2002
Summary
Adults with choledochal cysts rarely develop biliary tract malignancy, but when they do, it presents uniquely with higher rates of prior drainage and cholangitis. Surgical outcomes differ significantly based on malignancy presence.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Choledochal cysts are uncommon in adults.
- Malignancy complicates choledochal cysts, leading to poor prognosis despite surgery.
Purpose of the Study:
- To compare clinical presentation, management, and outcomes of adult choledochal cyst patients with and without biliary tract malignancy.
- To identify factors associated with malignancy in adult choledochal cyst cases.
Main Methods:
- Retrospective study of 30 adult patients with choledochal cysts from 1989-2000.
- Analysis of clinical presentation, surgical management, and patient outcomes.
- Comparison between patients with (n=9) and without (n=21) biliary tract malignancy.
Main Results:
- 30% of adult choledochal cyst patients had biliary tract malignancy.
- Malignancy group showed higher incidence of prior internal drainage (P=.049) and cholangitis (P=.03).
- Median survival for malignancy group was 12 months; no long-term complications in non-malignancy group with median 66-month follow-up.
Conclusions:
- Suspect biliary tract malignancy in adults with choledochal cysts presenting with cholangitis and prior internal drainage.
- Complete excision and Roux-en-Y hepaticojejunostomy are optimal for non-malignant cases, with low morbidity.
- Malignancy significantly worsens prognosis in adult choledochal cyst patients.