Management of biliary cystic tumors: A multi-institutional analysis of a rare liver tumor

Dean J. Arnaoutakis, Yuhree Kim, Carlo Pulitano, Victor Zaydfudim, Malcolm H. Squires, David Kooby, Ryan Groeschl, Sorin Alexandrescu, Todd W. Bauer, Mark Bloomston, Kevin Soares, Hugo Marques, T. Clark Gamblin, Irinel Popescu, Reid Adams, David Nagorney, Eduardo Barroso, Shishir K. Maithel, Michael Crawford, Charbel SandroussiWallis Marsh, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

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

Original languageEnglish (US)
Pages (from-to)361-367
Number of pages7
JournalAnnals of Surgery
Volume261
Issue number2
DOIs
StatePublished - 2015

Keywords

  • Biliary cystadenocarcinoma
  • Biliary cystadenoma
  • Cyst
  • Liver

ASJC Scopus subject areas

  • Surgery

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