Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

Abstract Purpose Approximately 1 to 3.5% of cholecystectomies are found to have incidental dysplasia on histological examination. Cases of positive resection margins on the cystic stump are rare and evidence lack. The aim of this article was to systematically review the literature and to suggest a possible management algorithm. Methods We searched PubMed, Cochrane Library and Google Scholar databases by combining “cholecystectomy” AND “dysplasia” AND “cystic” according to PRISMA guidelines. Studies providing information about cystic duct dysplasia with positive resection margin after cholecystectomy were included. Results The searches identified 109 articles from PubMed and 4 articles from Cochrane Library and Google Scholar, of which three were eligible. Five were found to have post-operative high-grade dysplasia, one patient had a carcinoma and one had a low-grade dysplasia. Median follow-up was of 10.5 months (range: 0.5 – 26.6 months), no evidence of recurrence was found in patients with dysplasia, while the patient with diagnosis of cholangiocarcinoma died during follow-up. Conclusions Patients with positive resection margins for dysplasia after cholecystectomy should be considered for a surgical treatment. The latter depends on several factors related to the patient and the grade of dysplasia itself. Simple cystic duct stump excision has been suggested and it seems to be safe and effective with no evidence of recurrence during follow-up when a R0 resection is achieved. A multidisciplinary approach and a surveillance program should be always taken into account.