The Efficacy and Safety of Intrapancreatic Bile Duct Resection Applied in Type I of Congenital Bile Duct Dilation: A Multicenter Control Cohort Study

Abstract

Objective: To compare the efficacy and safety of radical extrahepatic cyst excision (REC), which includes the intrapancreatic bile duct (IPBD), and subtotal extrahepatic cyst excision (SEC), which preserves the IPBD, in treating Todani type I congenital bile duct dilation with IPBD involvement (I-IPBD).

Background: The application of REC and SEC in I-IPBD remains debated.

Methods: The multicenter study recruited I-IPBDs who underwent REC or SEC from 5 centers between 2006 and 2024. The primary endpoint was occurrence of long-term complications, including recurrent cholangitis, pancreatitis, and IPBD stones. The secondary outcomes included readmission, reoperation, life quality assessed by Mayo score, carcinogenesis, and perioperative complications categorized as overall, severe, pancreas-related, and severe pancreas-related.

Results: Three hundred fifty-five I-IPBDs were included and divided into the REC group (175 cases) and SEC (180 cases) from 722 type I congenital bile duct dilations. The REC group demonstrated better long-term complication-free survival compared with SEC group (log-rank P < 0.001; hazard ratio = 0.08, 95% CI: 0.04-0.15, P < 0.001). The REC group had lower rates of readmission, reoperation, and carcinogenesis, and achieved a superior Mayo score ( P < 0.05). No significant differences were observed between the REC and SEC groups in overall perioperative complications, severe perioperative complications, and severe pancreas-related perioperative complications ( P > 0.05). Furthermore, subgroup analysis by age demonstrated similar trends in primary and secondary outcomes compared with the overall analysis.

Conclusions: REC was an effective and safe surgical approach for I-IPBD compared with SEC, thus it should be recommended routinely for these patients.

Keywords: congenital bile duct dilation; intrapancreatic bile duct; long-term outcome; perioperative complication; radical resection.

FIGURE 1

Todani type I CBD involving the IPBD and surgical approaches. A, MRCP of the I-IPBD. B, Extent of resection. Red dotted line indicates REC, blue dotted line indicates SEC. C and D, Operative photographs of REC, defined as the radical resection of the extrahepatic cyst including the IPBD cyst down to the pancreaticobiliary junction.

FIGURE 2

Kaplan-Meier analysis for long-term complications before and after IPTW. A, Kaplan-Meier analysis for long-term complications before IPTW. B, Kaplan-Meier analysis for long-term complications after IPTW.