To evaluate the correlation between biliary-enteric surgical drainage and the late development of cholangiocarcinoma of the biliary tract. In patients with biliary-enteric drainage, reflux of intestinal contents into the bile duct may occur and cause cholangitis, which is regarded as the most serious complication of these procedures. Lithiasis of the biliary tract and a previous biliary-enteric anastomosis have both been suggested to favor the late onset of cholangiocarcinoma. Consecutive patients (n = 1,003) undergoing three different procedures of biliary-enteric anastomosis (transduodenal sphincteroplasty, choledochoduodenostomy, and hepaticojejunostomy) between 1967 and 1997 were included in this study. The postoperative clinical course and long-term outcome were evaluated by a retrospective review of the hospital records and follow-up. Mean follow-up was 129.6 months. Fifty-five (5.5%) cases of primary bile duct cancer were found among the 1,003 patients at intervals of 132 to 218 months from biliary-enteric anastomosis. The incidence of cholangiocarcinoma in the three groups was 5.8% in transduodenal sphincteroplasty patients, 7.6% in choledochoduodenostomy patients, and 1.9% in hepaticojejunostomy patients. The incidence of malignancy related to the different underlying diagnosis was 5.9%, 7.2%, and 1.9% in patients with choledocholithiasis, sphincter of Oddi stenosis, and postoperative benign stricture, respectively. Although only one patient who developed cholangiocarcinoma had previous concurrent lithiasis of the biliary tract, 40 patients had experienced mostly severe, recurrent cholangitis. No case of malignancy occurred in patients scored as having no cholangitis in the early and long-term postoperative outcome. Univariate and multivariate analyses have shown the presence of cholangitis as the only factor affecting the incidence of cholangiocarcinoma. Chronic inflammatory changes consequent to biliary-enteric drainage should be closely monitored for the late development of biliary tract malignancies.

Research from JAMA Surgery — Surgical Treatment of Pancreatic Head Carcinoma in Elderly Patients

Research from JAMA Surgery — Adenocarcinoma of the Third and Fourth Portions of the Duodenum — Results of Surgical Treatment

SYMPTOMATIC nonparasitic hepatic cysts (SNHC) are frequent incidental findings at laparotomy and more so recently because of the increasing use and refinement of abdominal imaging and ultrasonography.^1-3 Determining the precise incidence of this disease is difficult; reports range from 0.10% to 4.7% according to autopsy, surgical, and ultrasonographic series.^1,2 Symptomatic nonparasitic hepatic cysts may be congenital or acquired and are encountered more often in women and in individuals older than 60 years.^4-6 They arise from the aberrant development of intrahepatic biliary radicals.⁷ These cysts are lined by a single layer of cuboidal or columnar epithelium resembling that of bile ducts.^5,6,8,9 Evidence of a biliary origin is also provided by the composition of the fluid contained in the cyst.¹⁰ Rare SNHCs may be lined by squamous epithelium, and these cysts may be complicated by the development of squamous cell carcinoma.¹¹ Most SNHCs are asymptomatic and require no treatment; treatment is indicated when they become highly symptomatic, cause complications, or demonstrate rapid growth.^12-19 Despite the rare occurrence and the more rare indication for treatment of these lesions, many options for their management have been proposed.^{5,10,11,20,21} We assessed our experience in the treatment of symptomatic SNHC for more than 2 decades. Although the term nonparasitic includes cysts secondary to trauma or inflammation, only congenital cysts are discussed herein.