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Surgical Experience of 204 Cases of Adult Choledochal Cyst Disease over 14 Years

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Abstract

Background

This study presents our 14-year surgical experience with adult choledochal cyst disease (CCD), focusing on the clinical outcomes after surgical treatment.

Methods

Medical records of 204 adult patients who had undergone surgery for CCD were reviewed retrospectively.

Results

Median patient age was 40.2 years, and 157 (77%) of the patients were female. Todani classification was type I in 116 patients (56.9%), type II in 1 patient (0.5%), type IVa in 86 patients (42.2%), and type V in 1 patient (0.5%). Extrahepatic cyst excision and hepaticojejunostomy were performed in 185 patients (90.7%). Major perioperative complications occurred in 5 patients (2.5%), resulting in no mortality. Late complications occurred in 48 patients (23.6%). Concurrent cancer was diagnosed in 20 patients (9.8%). Mean age of patients with or without biliary cancer was 48.1 ± 13.2 years and 39.1 ± 11.8 years, respectively (P = 0.001). Anomalous union of the pancreaticobiliary duct was more frequently associated with gallbladder cancer than with bile duct cancer. De novo malignancy at the cyst remnant occurred in 2 patients (1%). The survival outcomes in CCD patients with concurrent biliary cancer were comparable to those in cancer patients without CCD.

Conclusions

As a result of diverse features of adult CCD, various clinical problems occurred after surgical excision. Surgical treatment for adult patients with CCDs having complex features should be individualized to maintain a balance between risk of surgery and potential risk of late complications.

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Acknowledgments

The present study was conceived and designed by Hwang S, Cho MJ, Lee SG; data acquisition was accomplished by Cho MJ, Hwang S, Kim KH, Ahn CS, Moon DB, Lee SS, Park DH; data analysis and interpretation were completed by Hwang S, Cho MJ, Lee YJ, Lee SK, Kim MH; and drafting of the manuscript was done by Hwang S, Cho MJ, Lee SG, Lee SK, Kim MH, with critical revision by Hwang S, Cho MJ, Lee SG.

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Authors and Affiliations

  1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea

    Min-Jeong Cho, Shin Hwang, Young-Joo Lee, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon & Sung-Gyu Lee

  2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea

    Sung-Koo Lee, Myung-Hwan Kim, Sang-Soo Lee & Do-Hyun Park

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  1. Min-Jeong Cho
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  2. Shin Hwang
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  3. Young-Joo Lee
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  11. Sung-Gyu Lee
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Correspondence to Shin Hwang.

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Cho, MJ., Hwang, S., Lee, YJ. et al. Surgical Experience of 204 Cases of Adult Choledochal Cyst Disease over 14 Years. World J Surg 35, 1094–1102 (2011). https://doi.org/10.1007/s00268-011-1009-7

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