Anomalous union of the pancreaticobiliary duct without choledochal cyst: is cholecystectomy alone sufficient?

Abstract

Anomalous union of the pancreaticobiliary duct (AUPBD) is frequently associated with choledochal cyst and biliary tract cancers. Management of AUPBD with choledochal cyst consists of extrahepatic bile duct excision and cholecystectomy. In cases of AUPBD without choledochal cyst, cholecystectomy alone is usually recommended. This study aimed to evaluate the occurrence of biliary tract cancer in AUPBD patients in order to assess the validity of the currently recommended operative management. Of a total of 10,255 endoscopic retrograde cholangiopancreatography cases performed at two Korea University hospitals from 2001 to 2010, 55 (0.54 %) cases of AUPBD were identified. Patients with AUPBD were divided according to its subtype (P-C union and C-P union) and the presence of choledochal cyst for analysis. The occurrence of benign and malignant disease was evaluated and compared between the groups. Gallbladder stones were more frequently found in AUPBD patients without choledochal cyst (p = 0.032). Biliary tract cancer occurred more frequently in P-C union (p = 0.050), especially the common bile duct cancer (p = 0.023). When analyzed according to the presence of choledochal cyst, biliary tract cancer occurred more frequently in AUPBD patients without choledochal cyst (p = 0.005), with bile duct cancer being significantly more common (p = 0.015). However, there was no difference in the presence of gallbladder cancer between the two groups (p = 0.318). Since cancers of the biliary tract occur more frequently in the AUPBD group without choledochal cyst, cholecystectomy alone may not be protective of the future occurrence of bile duct cancers, and thus, vigilant surveillance is necessary in this population group.