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Updated: Sep 18, 2025
04:14
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
237
Carcinoma sequence inferred from increasing age at choledochal cyst excision
Derek A Riffert1, Heidi Chen2, James L Rogers1
1Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN.
Surgery
|June 25, 2025
Summary
Choledochal cysts can progress to biliary carcinoma. This study found that older age at resection increases cancer risk, recommending screening for patients over 30.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Choledochal cysts are associated with an increased risk of biliary carcinoma.
- The age-related progression of biliary epithelial transformation within choledochal cysts is not well understood.
- This study investigates the sequence of cancer development in choledochal cysts across different age groups.
Purpose of the Study:
- To elucidate the pathway of biliary carcinoma development in choledochal cysts.
- To characterize age-related changes in biliary epithelium within choledochal cysts.
- To inform cancer risk assessment and screening strategies for patients with choledochal cysts.
Main Methods:
- Retrospective analysis of patients with choledochal cysts or biliary carcinoma (1988-2023).
- Pathological review of choledochal cyst specimens for epithelial changes.
- Logistic regression analysis to assess the association between age and epithelial transformation.
Main Results:
- Among 130 choledochal cyst patients, median resection age was 12 years; 6.9% showed epithelial transformation (metaplasia, hyperplasia, dysplasia, carcinoma).
- Older age at excision (≥17 years) significantly increased odds of epithelial transformation (OR=15.0, P=.0093).
- Median age increased sequentially from premalignant changes (34 years) to carcinoma with cysts (51 years) to carcinoma without cysts (65 years).
Conclusions:
- Biliary epithelial transformation to carcinoma in choledochal cysts correlates with increasing age at resection.
- A case of metachronous biliary carcinoma highlights long-term risk.
- Screening for biliary carcinoma is recommended for patients with a history of choledochal cyst excision starting at age 30.
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