Article

Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 15, Issue 1, pp 15-24

First online:

Risk factors for biliary tract and ampullary carcinomas and prophylactic surgery for these factors

  • Masaru MiyazakiAffiliated withDepartment of General Surgery, Chiba University Graduate School of Medicine
  • , Tadahiro TakadaAffiliated withDepartment of Surgery, Teikyo University School of Medicine
  • , Shuichi MiyakawaAffiliated withDepartment of Gastroenterological Surgery, Fujita Health University
  • , Kazuhiro TsukadaAffiliated withDepartment of Surgery and Science, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama
  • , Masato NaginoAffiliated withDivision of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • , Satoshi KondoAffiliated withDepartment of Surgical Oncology, Hokkaido University Graduate School of Medicine
  • , Junji FuruseAffiliated withHepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East
  • , Hiroya SaitoAffiliated withDepartment of Radiology, Asahikawa Kosei General Hospital
  • , Toshio TsuyuguchiAffiliated withDepartment of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine
    • , Kazuo ChijiiwaAffiliated withDepartment of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine
    • , Fumio KimuraAffiliated withDepartment of General Surgery, Chiba University Graduate School of Medicine
    • , Hideyuki YoshitomiAffiliated withDepartment of General Surgery, Chiba University Graduate School of Medicine
    • , Satoshi NozawaAffiliated withDepartment of General Surgery, Chiba University Graduate School of Medicine
    • , Masahiro YoshidaAffiliated withDepartment of Surgery, Teikyo University School of Medicine
    • , Keita WadaAffiliated withDepartment of Surgery, Teikyo University School of Medicine
    • , Hodaka AmanoAffiliated withDepartment of Surgery, Teikyo University School of Medicine
    • , Fumihiko MiuraAffiliated withDepartment of Surgery, Teikyo University School of Medicine

Abstract

Curative resection is the only treatment for biliary tract cancer that achieves long-term survival. However, patients with advanced biliary tract cancer have only a limited prognosis even after radical surgical resection. Thus, to improve the longterm results, the early detection of biliary tract cancer and subsequent cure seem to be essential. The purpose of this study was to review the literature concerning the risk factors for cancerous and precancerous lesions of the biliary tract, and prophylactic surgery for these factors. It has been reported that pancreaticobiliary maljunction (PBM) with bile duct dilatation is a risk factor for gallbladder cancer and bile duct cancer, while PBM without bile duct dilatation is a risk factor for gallbladder cancer. Thus, in the former group, a prophylactic excision of the common bile duct and gallbladder should be recommended, while in the later group, a prophylactic cholecystectomy without bile duct resection may be the appropriate surgical procedure. It has also been reported that primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma. Patients with PSC often develop advanced cholangiocarcinoma with a poor prognosis. In patients with PSC, therefore, strict follow-up should be recommended. Adenoma and dysplasia have been regarded as precancerous lesions of gallbladder cancer. A polypoid lesion of the gallbladder that is sessile, has a diameter greater than 10 mm, and /or grows rapidly, is highly likely to be cancerous and should be resected. Although gallstones seem to be closely associated with gallbladder cancer, there is no evidence of a direct causal relationship between gallstones and gallbladder cancer. Thus, a cholecystectomy is not advised for asymptomatic cholecystolithiasis. Controversy remains as to whether adenomyomatosis of the gallbladder and porcelain gallbladder are associated with gallbladder cancer. With respect to ampullary carcinoma, adenoma of the ampulla is considered to be a precancerous lesion. This article discusses the risk factors for cancerous and precancerous lesions of the biliary tract and prophylactic treatment for these factors.

Key words

Biliary tract neoplasms Risk factors Prophylaxis therapy Gallstones Pancreaticobiliary maljunction Precancerous conditions Gallbladder Guidelines