To delineate the natural progression of choledochal cysts (CCs) in adult patients and inform personalized therapeutic strategies.
Approach:
Study Design: A retrospective analysis was conducted on cases diagnosed with Todani type I CCs from 1990 to 2023, excluding pediatric patients and those with incomplete records.
Definitions: Todani type I CCs were classified according to the 1977 Todani classification, and postoperative complications were graded using the Clavien-Dindo classification system.
Imaging: Diagnosis was established through abdominal ultrasound, CT, MRI/MRCP, or ERCP, focusing on cystic dilation of the extrahepatic bile duct.
Pathology: Resected specimens were examined for histopathological confirmation of CCs, characterized by dense collagenous tissue.
Key Findings:
Type I choledochal cysts are the most prevalent subtype in adults, found in 68% of patients in a large multi-institutional Korean study.
The risk of malignancy in adults with CCs is lower than previously reported, with a prevalence of 7.5% in a pooled analysis of 78 studies.
Adult presentations may lack the classical triad of symptoms, complicating diagnosis.
Interpretation:
Management recommendations are primarily based on pediatric studies, with adult cases presenting unique challenges.
Limitations:
Observational studies of adult populations are limited, particularly in Western contexts.
Standardized guidelines for diagnosis and care are unestablished.
Conclusion:
The study highlights the need for personalized treatment strategies for adults with choledochal cysts, considering the unique challenges in presentation and management.
by Sonal Walia, Mohammed Saad, James Butler, Ryan J. Ellis, Thomas K. Maatman, Trang Nguyen, C. Max Schmidt, Nicholas J. Zyromski, Eugene P. Ceppa, Attila Nakeeb, Omer Saeed, Michael G. House, Alex M. Roch
