Oncologic safety of Carrel patch hepaticojejunostomy for treating cystic-type choledochal cyst in children based on 20-plus years follow-up
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In brief
In brief
This 20+ year follow-up study of 83 pediatric choledochal cyst patients demonstrates that Carrel patch hepaticojejunostomy is oncologically safe with no malignant transformation, while reducing anastomotic stenosis (2.3% vs 12.5%) and eliminating intrahepatic bile duct stones compared to conventional anastomosis.
Written by the GCMD Library team from the article.
Abstract
Aim
During choledochal cyst (CC) excision, the hepaticojejunostomy anastomosis (HJA) can be performed conventionally (CHJA) or with a Carrel patch (CPA). CPA can increase CHD diameter to 10–13 mm, preventing anastomotic stenosis and intrahepatic bile duct (IHBD) stones but may be at risk for malignant transformation.
Methods
The medical records of 83 cystic-type CC with CHD ≤ 9 mm followed up for at least 20 years were reviewed retrospectively. Available excised CC specimens (70/83) were re-examined blindly for pre-malignant changes. A questionnaire about suturing narrow lumens was conducted.
Results
All 83 had pancreaticobiliary maljunction. Group data were similar. Anastomoses were CPA (n = 43) and CHJA (n = 40). Mean diameter for CPA was 11.4 mm (range: 10–13 mm); for CHJA was 7.4 mm (range: 5–9 mm). Mean follow-up was 27.7 years (range: 20–42). Postoperative anastomotic stenoses were less after CPA: 1/43 (2.3%) versus 5/40 (12.5%) (p = 0.10), but CHJA had significantly more postoperative IHBD stones: 0% versus 4/40 (10.0%) (p < 0.05). All IHBD stone patients had anastomotic stenosis. Excised specimens showed no pre-malignant cytology. Lumen diameter ≤ 9 mm was considered challenging by 10/10 surgical trainees and ≤ 7 mm by 16/22 pediatric surgeons.
Conclusions
CPA appears to be oncologically safe because of the absence of malignant transformation for at least 20 years.