Intrahepatic Versus Extrahepatic Biliary Tree Cysts: Outcomes after Surgical Resection in a Multicentric Study

Abstract

Background:

Biliary tree cysts (BTCs) are rare congenital dilatations of the bile ducts associated with an increased risk of acute cholangitis and cholangiocarcinoma (CCA). Over the past two decades, surgical resection has become the standard of care in the management of BTCs. The most widely accepted classification, introduced by Todani in 1977, is based on cyst morphology. However, from a surgical perspective, BTCs can also be categorized by location as intrahepatic, extrahepatic, or mixed.

Methods:

We conducted a retrospective analysis of 31 patients who underwent surgical resection for BTCs between 2005 and 2021 at two centers: Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) and Ospedale San Paolo (Savona, Italy). Patients were divided into two groups based on cyst location: intrahepatic (IHG) and extrahepatic (EHG). Perioperative data, postoperative complications, oncological outcomes, and long-term survival were compared between groups.

Results:

A total of 31 patients were included: 15 in the IHG and 16 in the EHG. Baseline characteristics were similar across groups. The median operative time was 196 minutes (range: 120–300) in the IHG and 156 minutes (range: 90–240) in the EHG (P = .073). There were no significant differences in postoperative complications. Median postoperative hospital stay was 12 days (range: 5–34) in the IHG and 18 days (range: 7–39) in the EHG (P = .123). After a median follow-up of 68 months, 26 patients (83.9%) were alive and in good clinical condition. Three patients died from causes unrelated to surgery, while 2 patients—both with histologically confirmed CCA—died from disease progression. No significant difference in overall survival was observed between the two groups (P = .192).

Conclusion:

Surgical resection of BTCs is safe and feasible. Perioperative outcomes and long-term survival are comparable between intrahepatic and extrahepatic BTCs, supporting surgery as an effective treatment regardless of cyst location.