Soares and colleagues1 are to be commended for assembling a large, multicenter analysis of children and adults with resected choledochal cysts (CCs). Although the study provides useful information, it has several limitations including the retrospective design, the long time span reviewed, and the fact that most patients analyzed had symptomatic disease. As is the case in most surgical series, the risk of associated cancer may be overstated since the true denominator of patients with asymptomatic disease is unknown. Furthermore, although surgical intervention in symptomatic patients is straightforward, treatment recommendations for the asymptomatic patient are more controversial. The series presented by Soares et al1 offers little guidance for this more vexing clinical problem.
Linehan D, Galka E. Lingering Questions on Choledochal Cysts. JAMA Surg. 2015;150(6):584. doi:10.1001/jamasurg.2015.0233