title: Choledochal cyst and associated malignant tumors in adults: a multicenter survey in South Korea.
abstract: OBJECTIVE
  To determine the clinical features and clinical outcomes of Korean adults treated surgically for choledochal cyst.
  
  
  METHODS
  Retrospective nationwide multicenter study.
  
  
  METHODS
  Fifteen university hospitals (tertiary care referral centers) located in all 7 Korean provinces.
  
  
  METHODS
  A total of 808 patients aged 18 years or older who underwent surgery for choledochal cyst from January 1, 1990, through December 31, 2007.
  
  
  METHODS
  Demographic information, surgical data, associated biliary malignant tumors, and factors predicting malignant tumors.
  
  
  RESULTS
  Type I was most common (499 [68.2%]) followed by type IVa (208 [28.4%]). Of 654 patients, anomalous pancreaticobiliary ductal union was identified in 467 patients (71.4%), 291 with the choledochal type (62.3%), 96 with the pancreatic type (20.6%), and 80 with the complex type (17.1%). Biliary tract malignant tumor was associated in 80 patients (9.9%); 40 had bile duct cancer (50.0%), 35 had gallbladder cancer (43.8%), 3 had periampullary cancer, and 2 had synchronous gallbladder and bile duct cancer. Twenty-two patients (26.3%) had a recurrence, with a median follow-up duration of 51.8 months. Factors predicting malignant tumor by univariate analysis were age more than 40 years, the absence of a gallstone, elevated carcinoembryonic antigen or cancer antigen 19-9 serum level, and the presence of anomalous pancreaticobiliary ductal union, and by multivariate analysis, an elevated cancer antigen 19-9 level.
  
  
  CONCLUSIONS
  Associated biliary malignant tumor should always be considered in patients with choledochal cyst, especially in aged patients or patients with anomalous pancreaticobiliary ductal union or an elevated tumor marker level. Lifelong follow-up is needed even after complete cyst excision because of the risk of the development of a metachronous biliary malignant tumor.
authors: Department of Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
authors: Seung Eun
authors: SE
authors: Lee
authors: Jin-Young
authors: JY
authors: Jang
authors: Young-Joo
authors: YJ
authors: Lee
authors: Dong Wook
authors: DW
authors: Choi
authors: Woo Jung
authors: WJ
authors: Lee
authors: Baik-Hwan
authors: BH
authors: Cho
authors: Sun-Whe
authors: SW
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015529:Choledochal Cyst / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult