Abstract
BackgroundThe purpose of this study was to compare the impact of the extent of excision and the patent bile duct flow on treatment outcomes of bile duct cysts (BDCs).MethodsWe retrospectively analyzed the records of 382 patients who received surgery for BDCs from January 2005 to December 2014.ResultsFor Type Ia cysts, proper bile flow was associated with good long-term treatment outcomes with a greater level of significance (p < 0.001) than complete excision (p = 0.012). For Type IVa cysts, proper bile flow, but not complete excision, was associated with good long-term outcomes (p < 0.00001). In addition, 96.3% (104/108) of Type IVa patients with proper bile flow had no late complications and good biliary function, while no patient without patent bile flow had a good clinical outcome. For Type Ic cysts, 92 patients who received partial excisions had good outcomes when proper bile flow was restored. Regression analysis revealed that the absence of proper bile flow, in comparison to incomplete excision, is a greater risk factor for poor long-term treatment effects for Type Ia and Type IVa cysts.ConclusionsCompared to complete excision, the establishment of proper bile flow exerted a greater impact on improving long-term clinical outcomes after BDC surgery.
Highlights
The purpose of this study was to compare the impact of the extent of excision and the patent bile duct flow on treatment outcomes of bile duct cysts (BDCs)
Abdominal infections were treated with antibiotics, while two cases were treated with ultrasound-guided puncture and drainage
Our results show that for Type Ia bile duct cysts, complete excision of the lesioned bile duct significantly reduced the incidence of late complications and improved biliary function, the presence of proper bile flow impacted these clinical outcomes with a greater level of significance
Summary
The purpose of this study was to compare the impact of the extent of excision and the patent bile duct flow on treatment outcomes of bile duct cysts (BDCs). Long-term postoperative complications of adult CCs can be as high as 80% [3,4,5,6, 10, 11]. Cholangiocarcinoma is more frequent in Complete/radical cyst excision plus Roux-en-Y hepatojejunostomy has substantially reduced the incidence of postoperative long-term complications and cancer in patients with CCs [10, 15,16,17,18]. Radical excision of CCs is considered the gold standard for the treatment of Todani Type I and Type IV CCs, and it is believed that incomplete cyst excision is associated with poorer clinical outcomes and a greater risk of malignancy [7, 19]. We have addressed the issue of surgical approach at our institution, and our findings support the effectiveness of complete excision in reducing the rate of complications and cancer [8, 15]
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