| Theme |
Recent Issues of Pancreaticobiliary Maljunction |
| Title |
Validity and Controversial Issues Underlying Resection of Extrahepatic Duct for Pancreaticobiliary Maljunction without Associated Biliary Dilatation in Adults |
| Author |
Toshiki Matsubara |
Department of Surgery, Fujita Health University School of Medicine |
| Author |
Takahiko Funabiki |
Department of Surgery, Fujita Health University School of Medicine |
| Author |
Masahiro Ochiai |
Department of Surgery, Fujita Health University School of Medicine |
| Author |
Yoichi Sakurai |
Department of Surgery, Fujita Health University School of Medicine |
| Author |
Shigeru Hasegawa |
Department of Surgery, Fujita Health University School of Medicine |
| Author |
Hiroki Imazu |
Department of Surgery, Fujita Health University School of Medicine |
| [ Summary ] |
In patients with pancreaticobiliary maljunction (PBM), the association of biliary dilatation is an important diagnostic point, since its pathophysiology, clinical manifestations and treatment have been believed to be distinct, depending on whether or not the cases are associated with biliary dilatation. However, because the biliary tree of patients with PBM includes a wide variety of configurations and because of the absence of a generally accepted definition of biliary dilatation, there are some cases in which we have difficulty in determining associations with biliary dilatation. It has generally been believed that, in contrast to PBM cases with biliary dilatation, the incidence of bile duct carcinoma is relatively low in patients with PBM without biliary dilatation. Therefore, simple cholecystectomy for patients with PBM without obvious clinical symptoms is, selected as the operation of choice in some institutions. However, our recent studies demonstrated that alterations in somegenes, related to the carcinogenesis of biliary epithelium in patients with PBM, occur regardless of biliary dilatation, suggesting that resection of the bile duct is necessary to eradicate the biliary epithelium, which has a high carcinogenic potential. These data clearly indicated that resection of the extrahepatic biliary duct associated with cholecystectomy for patients with PBM without the association of biliary dilatation prevents biliary carcinoma that could potentially occur in the future. Despite this evidence, the extent of resection of the biliary duct for complete prevention of biliary carcinogenesis still remains controversial. Furthermore, since the benefits of resection of the extrahepatic bile duct in preventing biliary carcinogenesis should be balanced against the operative risks for these patients, postoperative complicationsand surgical invasiveness of the operation should carefully be evaluated. Preparation of generally accepted criteria or classification of PBM, as well as further basic research regarding the mechanism of biliary carcinogenesis, is required to determine optimal surgical approachs for patients with PBM. |