title: Risk factors for biliary tract and ampullary carcinomas and prophylactic surgery for these factors.
abstract: Curative resection is the only treatment for biliary tract cancer that achieves long-term survival. However, patients with advanced biliary tract cancer have only a limited prognosis even after radical surgical resection. Thus, to improve the longterm results, the early detection of biliary tract cancer and subsequent cure seem to be essential. The purpose of this study was to review the literature concerning the risk factors for cancerous and precancerous lesions of the biliary tract, and prophylactic surgery for these factors. It has been reported that pancreaticobiliary maljunction (PBM) with bile duct dilatation is a risk factor for gallbladder cancer and bile duct cancer, while PBM without bile duct dilatation is a risk factor for gallbladder cancer. Thus, in the former group, a prophylactic excision of the common bile duct and gallbladder should be recommended, while in the later group, a prophylactic cholecystectomy without bile duct resection may be the appropriate surgical procedure. It has also been reported that primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma. Patients with PSC often develop advanced cholangiocarcinoma with a poor prognosis. In patients with PSC, therefore, strict follow-up should be recommended. Adenoma and dysplasia have been regarded as precancerous lesions of gallbladder cancer. A polypoid lesion of the gallbladder that is sessile, has a diameter greater than 10 mm, and /or grows rapidly, is highly likely to be cancerous and should be resected. Although gallstones seem to be closely associated with gallbladder cancer, there is no evidence of a direct causal relationship between gallstones and gallbladder cancer. Thus, a cholecystectomy is not advised for asymptomatic cholecystolithiasis. Controversy remains as to whether adenomyomatosis of the gallbladder and porcelain gallbladder are associated with gallbladder cancer. With respect to ampullary carcinoma, adenoma of the ampulla is considered to be a precancerous lesion. This article discusses the risk factors for cancerous and precancerous lesions of the biliary tract and prophylactic treatment for these factors.
authors.affiliation: Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyakawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tsukada
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.forename: Hiroya
authors.initials: H
authors.lastname: Saito
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D012307:Risk Factors