Faculty Collaboration Database

Management of biliary cystic tumors: a multi-institutional analysis of a rare liver tumor. Ann Surg 2015 Feb;261(2):361-7

Date

02/11/2014

Pubmed ID

24509187

Pubmed Central ID

PMC4655107

DOI

10.1097/SLA.0000000000000543

Scopus ID

2-s2.0-84926950822 (requires institutional sign-in at Scopus site)   68 Citations

Abstract

OBJECTIVE: To characterize clinical and radiological features associated with biliary cystic tumors (BCTs) of the liver, and to define recurrence-free and overall survival.

BACKGROUND: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare tumors that arise in the liver.

METHODS: Between 1984 and 2013, 248 patients who underwent surgical resection of BCA or BCAC were identified. Clinical and outcome data were analyzed.

RESULTS: Median total bilirubin, CA19-9, and carcinoembryonic antigen (CEA) levels were 0.6 mg/dL, 15.0 U/mL, and 2.7 ng/mL, respectively. Preoperative imaging included computed tomography only (62.5%), magnetic resonance imaging only (6.9%), or CT + MRI (18.5%). Features on cross-sectional imaging included multiloculation (56.9%), mural nodularity (16.5%), and biliary ductal dilatation (17.7%). The presence of these factors did not reliably predict BCAC versus BCA (sensitivity, 81%; specificity, 21%). Median biliary cyst size was 10.0 cm (interquartile range, 7-13 cm). Operative interventions included unroofing/partial excision of the lesion (14.1%), less than hemihepatectomy (48.8%), or hemi-/extended hepatectomy (36.3%). On pathology most lesions were BCA (89.1%), whereas 27 (10.9%) were BCAC. At last follow-up, there were 46 (18.3%) recurrences; 2 patients who initially had BCA recurred with BCAC. Median overall survival was 18.1 years; 1-year, 3-year, and 5-year survival was 95.0%, 86.8%, and 84.2%, respectively. Long-term outcomes were associated with BCAC versus BCA, as well as the presence of spindle cell/ovarian stroma (both P < 0.05).

CONCLUSIONS: Among patients undergoing surgery for BCT, associated malignancy was uncommon (10%) and no preoperative findings reliably predicted underlying BCAC. After excision of BCA, long-term outcomes were good; however, patients with BCAC had a worse long-term prognosis.

Author List

Arnaoutakis DJ, Kim Y, Pulitano C, Zaydfudim V, Squires MH, Kooby D, Groeschl R, Alexandrescu S, Bauer TW, Bloomston M, Soares K, Marques H, Gamblin TC, Popescu I, Adams R, Nagorney D, Barroso E, Maithel SK, Crawford M, Sandroussi C, Marsh W, Pawlik TM

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms
Bile Ducts, Intrahepatic
Cystadenocarcinoma
Cystadenoma
Databases, Factual
Female
Follow-Up Studies
Hepatectomy
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Survival Analysis
Tomography, X-Ray Computed
Treatment Outcome
Young Adult