title: Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients.
abstract: OBJECTIVE
  To evaluate the correlation between biliary-enteric surgical drainage and the late development of cholangiocarcinoma of the biliary tract.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Chronic inflammatory changes consequent to biliary-enteric drainage should be closely monitored for the late development of biliary tract malignancies.
authors.affiliation: First Department of Surgery of the University of Rome La Sapienza Medical School, Rome, Italy. adraino.tocchi@uniroma1.it
authors.forename: A
authors.initials: A
authors.lastname: Tocchi
authors.forename: G
authors.initials: G
authors.lastname: Mazzoni
authors.forename: G
authors.initials: G
authors.lastname: Liotta
authors.forename: L
authors.initials: L
authors.lastname: Lepre
authors.forename: D
authors.initials: D
authors.lastname: Cassini
authors.forename: M
authors.initials: M
authors.lastname: Miccini
mesh_terms: D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000209:etiology*; D002768:Choledochostomy; D001651:Cholestasis, Extrahepatic / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic