Purpose: Surgical strategies for an adult choledochal cyst are influenced by the Todani-type, and the existence of a combined malignancy, This study was conducted to evaluate the characteristics of asymptomatic an adult choledochal cyst that influence the surgical strategy.
Methods: Fifty-seven adult patients (age≥16 years) received an operation for a choledochal cyst, at the Samsung medical center, between Aug, 1995 and Jul. 2003. Asymptomatic patients were defined as those diagnosed incidentally with a choledochal cyst, who had no symptoms related with a choledochal cyst. Evaluation of PBM (pancreaticobiliary maljunction) was available in 38 patients with a proper cholangiogram.
Results: There were 15 and 42 asymptomatic and symptomatic patients, respectively. The mean-age (38 years-old) and gender-ratio (M : F=14 : 43) were no different between the two groups. In preoperative blood tests the titers of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were slightly higher in the symptomatic group, but were still around the upper normal limit. The total bilirubin, amylase and CA19-9 levels were no different between the two groups. The operations in the symptomatic group required longer times and greater transfusion volumes than the asymptomatic group (4.5 vs. 3.5 hrs and 0.24 vs. 0 units, respectively). The proportion of the Todani-types, types of PBM, incidence of malignancy and gallstones were no different between the two groups. Seven malignancies, 3 common bile duct cancers and 4 gall bladder cancers, were found, and an age >40 years was the only risk factor of a combined malignancy.
Conclusion: There was no considerable difference to influence the surgical strategy between the asymptomatic and symptomatic choledochal cyst patients. However, old patients, especially over 40, may need a more aggressive surgical therapy.
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