Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review

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dc.contributor.advisorKrige, Jake E Jen_ZA
dc.contributor.advisorJonas, Eduarden_ZA
dc.contributor.authorKloppers, Jacobus Christoffelen_ZA
dc.date.accessioned2018-02-07T12:11:21Z
dc.date.available2018-02-07T12:11:21Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation. Aim: The aim of this study was to assess the outcome of surgical resection of BMCNs. Methods: Data from a departmental and faculty registered prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur and the University of Cape Town Private Academic Hospitals for BMCN from 1999 to 2015. Standard demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, post-operative complications using the Clavien-Dindo classification and long-term outcome. Results: Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by computer tomography scan after investigation of abdominal pain or a palpable mass. Two were jaundiced. One cyst was found incidentally during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated inappropriately with percutaneous aspiration or drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula of the left hepatic duct. Median operative time was 183 minutes (range: 130-375). No invasive carcinoma was found on histology. There was no operative mortality. One surgical site infection was treated and one patient developed an intra-abdominal collection one month post-operatively. Two patients developed recurrent BMCN after 24 months. Conclusion: BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures in particular may require technically complex liver resections and are best managed in a specialized hepato-pancreatico-biliary unit.en_ZA
dc.identifier.apacitationKloppers, J. C. (2017). <i>Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Surgical Gastroenterology. Retrieved from http://hdl.handle.net/11427/27400en_ZA
dc.identifier.chicagocitationKloppers, Jacobus Christoffel. <i>"Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Surgical Gastroenterology, 2017. http://hdl.handle.net/11427/27400en_ZA
dc.identifier.citationKloppers, J. 2017. Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Kloppers, Jacobus Christoffel AB - Background: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation. Aim: The aim of this study was to assess the outcome of surgical resection of BMCNs. Methods: Data from a departmental and faculty registered prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur and the University of Cape Town Private Academic Hospitals for BMCN from 1999 to 2015. Standard demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, post-operative complications using the Clavien-Dindo classification and long-term outcome. Results: Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by computer tomography scan after investigation of abdominal pain or a palpable mass. Two were jaundiced. One cyst was found incidentally during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated inappropriately with percutaneous aspiration or drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula of the left hepatic duct. Median operative time was 183 minutes (range: 130-375). No invasive carcinoma was found on histology. There was no operative mortality. One surgical site infection was treated and one patient developed an intra-abdominal collection one month post-operatively. Two patients developed recurrent BMCN after 24 months. Conclusion: BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures in particular may require technically complex liver resections and are best managed in a specialized hepato-pancreatico-biliary unit. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review TI - Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review UR - http://hdl.handle.net/11427/27400 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/27400
dc.identifier.vancouvercitationKloppers JC. Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Surgical Gastroenterology, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/27400en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Surgical Gastroenterologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherSurgical Gastroenterologyen_ZA
dc.titleResection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature reviewen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPhilen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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