Does Dysplasia at the Cystic Duct Surgical Margin Remain at the Cystic Stump? A Literature Review.

Dysplasia (biliary intraepithelial neoplasia-BilIN) at the cystic duct surgical margin is uncommon. However, no clear guidelines exist regarding optimal management. This study aimed to evaluate management strategies for cystic duct dysplasia (BilIN) detected at the surgical margin based on the available literature. A literature search was conducted using PubMed and Google Scholar to identify reports of dysplasia or BilIN involving the cystic duct margin in patients undergoing cholecystectomy for benign indications. Eight studies comprising 12 cases were included. High-grade dysplasia was the predominant histopathological finding. Magnetic resonance cholangiopancreatography was performed in 10 cases and revealed findings suspicious for malignancy in two. Nine of 12 patients underwent complementary procedures. Two patients had low-grade dysplasia with negative surgical margins. One patient had a missed cholangiocarcinoma located at the distal cystic duct. In nine cases, only fibrosis was observed in the cystic duct stump. No malignant transformation was reported during follow-up. Routine complementary surgery for cystic duct margin dysplasia may represent overtreatment in the absence of suspicious radiologic findings. An image-guided, selective reoperation strategy appears appropriate.