Bile duct cysts in adults: Is it time to think about a tailored treatment?

Symptomatic bile duct cysts (BDC) usually request a surgical management, in which the gold standard is the complete cyst resection; even though malignant transformations of the cyst wall are currently described and analyzed, data on asymptomatic BDC in adults are still inaccurate. In fact, at present it is still debate what is the best treatment for asymptomatic BDC, which are usually discovered at imaging accidentally in adult population. Three patients affected by BDC (Todani type Ia, Iva and V) were treated with radical resection. None of the patients harboured a cholangiocarcinoma nor dysplasia in the specimen; however, they presented symptoms relief. The description of the surgical management hinted a digression on how BDC are treated worldwide and what is the target of surgical community. While treatment of BDC is commonly the complete cyst resection, further preoperative instrumental assessments and a cancer-risk scoring system which could drive the indication to resection vs. o...