Synchronous and metachronous biliary malignancy in adults undergoing complete excision of choledochal cysts: a systematic review and meta-analysis stratified by Todani type
A partir d'une revue systématique de la littérature publiée jusqu'en août 2026, cette méta-analyse évalue le risque synchrone et métachrone de cancer des voies biliaires après exérèse complète de kystes du cholédoque
Choledochal cysts carry a recognised lifetime risk of biliary malignancy, but published rates mix children with adults and cancers found at excision with cancers that arise afterwards. This systematic review and meta-analysis estimated adult-only synchronous and metachronous biliary malignancy after complete cyst excision and compared Todani types I and IVa. PubMed, Embase and Web of Science were searched on 16 August 2026 (PROSPERO CRD420261480488). Random-effects logit models with Hartung?Knapp confidence intervals and prediction intervals were used. During revision, 93 of 100 previously unretrieved reports were obtained and full-text eligibility was re-assessed independently by two reviewers. Twenty-one series (2660 adults; 186 events) informed the synchronous analysis and 21 series (1759 adults at risk; 17 events) the metachronous analysis. The pooled synchronous rate was 6.5% (95% CI 4.8-8.8; prediction interval 2.2-18.0; I2 59%). After complete excision in adults without baseline cancer, the pooled observed metachronous rate during available follow-up was 1.5% (1.1-2.2; prediction interval 0.7-3.5; I2 0%). Synchronous rates in Todani I and IVa cysts did not differ (7.4% versus 9.1%; odds ratio 1.05, 0.64-1.71). Certainty was low for the synchronous estimate and very low for metachronous disease and the type contrast. In adults selected for complete excision, the pooled prevalence of synchronous invasive biliary malignancy was 6.5%. New cancer after complete excision was uncommon in series with mostly short follow-up. Lifelong surveillance remains a reasonable implication of residual uncertainty about late events. Current evidence is insufficient to determine whether additional hepatectomy reduces malignancy risk in Todani IVa disease.
European Journal of Surgical Oncology , résumé, 2026