Prophylactic excision of the gallbladder and bile duct for patients with pancreaticobiliary maljunction

S. Kobayashi, T. Asano, M. Yamasaki, T. Kenmochi, K. Saigo, T. Ochiai

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Abstract

Hypothesis: Pancreaticobiliary maljunction (PBM) is a high-risk factor for biliary tract carcinogenesis because of a continuous reflux of pancreatic juice into the biliary tract. It remains to be disclosed whether we should perform prophylactic excision of gallbladders and bile ducts. Design: A person-year method. Setting: A university hospital. Patients: We studied 68 patients with PBM treated between August 1, 1974, and December 31, 1999. Main Outcome Measures: Relative risks (observed number-expected number ratios) of gallbladder and bile duct carcinomas according to type of bile duct dilation (ie, cystic dilation, diffuse dilation, and nondilation). Results: Observed number-expected number ratios of gallbladder carcinomas were high: 291.3 in 43 patients with cystic dilation, 167.2 in 16 patients with diffuse dilation, and 419.6 in 7 patients with nondilation. Observed number-expected number ratios of bile duct carcinomas were 194.2 in 43 patients with cystic dilation before surgery and 142.8 in 39 patients with cystic dilation after long postsurgical follow-up. All these values were statistically significant (P<.01). Conclusions: The gallbladder carries a high risk for carcinogenesis in all types of dilation in patients with PBM. The bile duct carcinomas of PBM were exclusively identified by the type of cystic dilation. Prophylactic cholecystectomy should be recommended for all dilation types, and prophylactic excision of bile ducts including cholecystectomy should be performed in patients with PBM and cystic dilation. Complete excision of extrahepatic dilated bile ducts and careful follow-up for carcinogenesis in residual dilated bile ducts should be recommended for patients with PBM and cystic dilation.

Original languageEnglish
Pages (from-to)759-763
Number of pages5
JournalArchives of Surgery
Volume136
Issue number7
DOIs
Publication statusPublished - 01-01-2001

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Bile Ducts
Gallbladder
Dilatation
Carcinoma
Carcinogenesis
Biliary Tract
Cholecystectomy
Extrahepatic Bile Ducts
Pancreatic Juice
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Kobayashi, S. ; Asano, T. ; Yamasaki, M. ; Kenmochi, T. ; Saigo, K. ; Ochiai, T. / Prophylactic excision of the gallbladder and bile duct for patients with pancreaticobiliary maljunction. In: Archives of Surgery. 2001 ; Vol. 136, No. 7. pp. 759-763.
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Prophylactic excision of the gallbladder and bile duct for patients with pancreaticobiliary maljunction. / Kobayashi, S.; Asano, T.; Yamasaki, M.; Kenmochi, T.; Saigo, K.; Ochiai, T.

In: Archives of Surgery, Vol. 136, No. 7, 01.01.2001, p. 759-763.

Research output: Contribution to journalArticle

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AU - Asano, T.

AU - Yamasaki, M.

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AU - Saigo, K.

AU - Ochiai, T.

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N2 - Hypothesis: Pancreaticobiliary maljunction (PBM) is a high-risk factor for biliary tract carcinogenesis because of a continuous reflux of pancreatic juice into the biliary tract. It remains to be disclosed whether we should perform prophylactic excision of gallbladders and bile ducts. Design: A person-year method. Setting: A university hospital. Patients: We studied 68 patients with PBM treated between August 1, 1974, and December 31, 1999. Main Outcome Measures: Relative risks (observed number-expected number ratios) of gallbladder and bile duct carcinomas according to type of bile duct dilation (ie, cystic dilation, diffuse dilation, and nondilation). Results: Observed number-expected number ratios of gallbladder carcinomas were high: 291.3 in 43 patients with cystic dilation, 167.2 in 16 patients with diffuse dilation, and 419.6 in 7 patients with nondilation. Observed number-expected number ratios of bile duct carcinomas were 194.2 in 43 patients with cystic dilation before surgery and 142.8 in 39 patients with cystic dilation after long postsurgical follow-up. All these values were statistically significant (P<.01). Conclusions: The gallbladder carries a high risk for carcinogenesis in all types of dilation in patients with PBM. The bile duct carcinomas of PBM were exclusively identified by the type of cystic dilation. Prophylactic cholecystectomy should be recommended for all dilation types, and prophylactic excision of bile ducts including cholecystectomy should be performed in patients with PBM and cystic dilation. Complete excision of extrahepatic dilated bile ducts and careful follow-up for carcinogenesis in residual dilated bile ducts should be recommended for patients with PBM and cystic dilation.

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