Choledochal Cyst or Benign Biliary Dilation: Is Resection Always Necessary?

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Radiology

Background:

• Choledochal cysts (CC) are typically diagnosed in early life, with surgical resection recommended due to malignancy risk.
• Increasing abdominal imaging reveals CC in older adults, but their management is less defined.
• This study investigates the significance of biliary duct anomalies in adult patients diagnosed with choledochal cysts.

Purpose of the Study:

• To evaluate the clinical significance and optimal management of choledochal cysts diagnosed radiographically in adult patients.
• To compare outcomes between surgical resection and observation for choledochal cysts in older adults.

Main Methods:

• Retrospective review of adult patients (≥18 years) diagnosed with choledochal cysts between 2006-2019.
• Analysis of demographics, comorbidities, surgical interventions, pathological findings, complications, readmissions, and follow-up imaging.
• Comparison of outcomes between patients who underwent resection and those managed with observation.

Main Results:

• 22 adult patients were identified; 40.9% underwent surgery, while the rest were observed.
• No high-grade dysplasia or invasive carcinoma was found in resected specimens.
• Post-resection complications occurred in 33.3% of surgical patients, whereas observed patients showed no cyst growth or malignant features over a median of 68 months.

Conclusions:

• Radiographically diagnosed choledochal cysts in older adults may represent a distinct clinical entity compared to pediatric cases.
• Close surveillance may be a preferable management strategy over surgical resection for choledochal cysts in adults, mitigating risks of long-term morbidity.