The impact of imaging on the surgical management of biliary cystadenomas and cystadenocarcinomas; a systematic review

• Published in: HPB (Oxford, England) Vol. 21; no. 10; pp. 1257 - 1267
• Main Authors: Klompenhouwer, Anne J., ten Cate, David W.G., Willemssen, Francois E.J.A., Bramer, Wichor M., Doukas, Michael, de Man, Robert A., Ijzermans, Jan N.M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2019
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2019.04.004

Biliary Cystadenomas (BCA) are considered to be benign but may transform to Biliary Cystadenocarcinomas (BCAC). The aim of this systematic review was to assess the diagnostic work-up and necessity of complete surgical resection. A systematic literature search was performed in Embase.com, Medline (Ovid), Cochrane Central, Web-of-Science and Google Scholar. Articles reporting on diagnostic work-up or outcome of various treatment strategies were included. Fifty-one articles with 1218 patients were included: 971 with BCA and 247 with BCAC. Patients with BCA were more often female (91% vs 63.8%, p < 0.001). On radiologic imaging BCAC more often had calcifications (p = 0.008), mural nodules (p < 0.001) and wall enhancement (p < 0.001). Reported treatment strategies were resection, enucleation, or fenestration/marsupialization. Recurrence was reported in 5.4% after resection for BCA and 4.8% after resection for BCAC. Recurrence after fenestration/marsupialization varied from 81.6% to 100% for both BCA as BCAC. Mortality rate was 0 in patients with BCA and 24% in BCAC. Due to the difficulty in accurately diagnosing these biliary cystic lesions and the availability of different surgical approaches, patients with suspected BCA or BCAC should be treated in a center specialized in liver surgery with state-of-the-art imaging and all surgical techniques to prevent mismanagement of this rare disease.