Choledochal cysts with malignancy in adult: A retrospective study with an experience of twenty-two years

Objective: To study the diagnosis, therapy, precaution, and prognosis after surgical treatments of malignant changes that occurred in adult choledochal cysts.

Methodology: We analysed retrospectively the clinicopathologic data, the ways of operative treatment and the survival time of patients with malignancy in 74 cases of adult choledochal cysts in our hospital from 1986 to 2008.

Results: Among the 74 patients, 9 cases (3 males and 6 females) had carcinomas arising from choledochal cysts at the mean age of 51.6 � 16.4 years (range: 22 to 72 years) with the prevalence of 12.2% (9/74), which was significant difference comparing with no malignant change groups (P=0.0037). The prevalence of malignancy for different groups were closely related to the age increased (r=0.363, p=0.011): 3.4% for 16-30 group (1/29), 8.7% for 31-45 group (2/23), 15.4% for 46-60 group (2/13), and 44.4% for 61-75 group (4/9), respectively. Surgical treatments included cysts excision with Roux-en-Y hepaticojejunostomy in three patients, cysts excision with cholangiojejunostomy in two patients, partial cyst excision with left lobectomy and Roux-en-Y hepaticojejunostomy, pancreatoduodenectomy, chemotherapy with implantable drug delivery system via hepatic artery and portal vein, and choledochotomy with T-tube drainage and metastatic lymph node biopsy in one patient, respectively. The survival time was from three months to 66 months with the mean survival of 19.1�18.6 months.

Conclusion: Choledochal cyst is a premalignant lesion, and the incidence of malignancy increases remarkably with the increase in age. Patients require close monitoring so that recurrent carcinoma of the remnant bile duct can be identified as early as possible.