Treatment and outcomes of adults with remnant intrapancreatic choledochal cysts.

Background: The purpose of this study is to report our experience with the treatment of remnant intrapancreatic choledochal cysts (CCs) in adults.

Methods: We reviewed retrospectively the records of patients with intrapancreatic remnant CCs who underwent reoperation by our surgical team from January 2000 to December 2012. Postoperative complications, surgical outcomes, and rate of malignancy were noted.

Results: A total of 41 patients were included: 35 without malignant transformation after the primary operation and 6 with malignant transformation. After the primary operation, all patients experienced cholangitis, and more than one-half had cholangiolithiasis (66%), pancreatitis (51%), and vomiting (51%). The mean age of the 35 patients (9 males and 26 females) was 49 years (range, 27-69), and the majority had originally a Todani type I cyst (74%). Most patients (74%) had undergone previously subtotal extrahepatic cyst excision and Roux-en-Y hepaticochojejunostomy. After excision of the remnant cyst, the rate of an excellent or good outcome was obtained in 91% of patients. The mean age of the patients with malignant transformation was 51 years (range, 35-70), and the rate of malignancy was 15% (6/41). The average time between the original incomplete CC excision and the diagnosis of malignancy was 140 months (range, 52-265). Four patients underwent pancreatoduodenectomy, and 2 underwent palliative surgery because the lesions were invading adjacent tissues. Five patients died of their disease within 37 months after reoperation.

Conclusion: Complications seem to be common after incomplete resection of a CC with remnant intrapancreatic CCs, and the malignancy rate is relatively high. To improve outcomes, all attempts at complete resection of the intrapancreatic portion of CCs should be made at the time of the primary operation.