Preferable operative age of choledochal dilation types to prevent patients with pancreaticobiliary maljunction from developing biliary tract carcinogenesis.
BACKGROUND
Pancreaticobiliary maljunction (PBM), which frequently accompanies choledochal dilation, is a high risk factor for biliary tract (gallbladder, bile duct) carcinoma because of the continuous reflux of pancreatic juice into the biliary tract. The aim of this study was to clarify the preferable operative age in PBM patients for the prevention of biliary tract carcinogenesis, with reference to the dilation types of bile ducts.


METHODS
There were 165 PBM patients in total studied, including 92 pediatric patients (< or =15 y) (cystic, 63; spindle-like, 29; nondilation, 0) and 73 adult patients (>15 y) (cystic, 45; spindle-like, 18; nondilation, 10) who underwent operative excision of extrahepatic bile ducts or cholecystectomy. We investigated incidence by age of biliary tract malignancies and the risk according to types of dilation.


RESULTS
In the pediatric group, no carcinoma case could be found preoperatively or postoperatively (mean follow-up period, 11.7 y). In the adult group, bile duct carcinomas could be detected in 6 cases of a cystic type (6 of 45; 13.3%) (3 preoperative, 3 postoperative). Among the bile duct carcinoma cases, the youngest patient was a 21-year-old woman who had undergone excision of an extrahepatic bile duct 3 years previously. Gallbladder carcinomas were detected in 16 patients: 3 of 45 cystic (6.7%), 6 of 18 spindle-like (33.3%), and 8 of 10 nondilation (80.0%), in whom the youngest patient was a 41-year-old woman with a spindle-like type.


CONCLUSIONS
To prevent biliary tract carcinogenesis in PBM patients, cystic-dilated choledochus should be excised in childhood before the development to a precancerous stage. In spindle-like and nondilation types, cholecystectomy is absolutely necessary in early adulthood before age 40.
Kobayashi
Susumu
S
Department of Surgery, Chiba Prefecture Hospital of Sawara, I-2285 Sawara, Sawara City, Chiba 287-0003, Japan. s.kbysh57@mc.pref.chiba.jp
Ohnuma
Naomi
N
Yoshida
Hideo
H
Ohtsuka
Yasuhiro
Y
Terui
Keita
K
Asano
Takehide
T
Ryu
Munemasa
M
Ochiai
Takenori
T
D000015:Abnormalities, Multiple / Q000145:classification / Q000601:surgery; D000328:Adult; D000367:Age Factors; D001652:Bile Ducts / Q000002:abnormalities*; D001661:Biliary Tract Neoplasms / Q000517:prevention & control*; D002675:Child, Preschool; D003135:Common Bile Duct; D003137:Common Bile Duct Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities*