Surgery · 2026
Serial carbohydrate antigen 19-9 monitoring reflects occult biliary abnormalities after surgery for choledochal cyst.
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Asai Hajime, Shirota Chiyoe, Uchida Hiroo, Makita Satoshi, Yasui Akihiro, Takimoto Aitaro, Hayashi Kaito, Ota Kazuki, Tainaka Takahisa
Аннотация
BACKGROUND: Carbohydrate antigen 19-9 is widely used as a pancreatobiliary biomarker; however, its value after choledochal cyst surgery remains unclear. Because long-term benign biliary complications predominantly occur after surgery for choledochal cyst requiring extrahepatic bile duct excision, we investigated the longitudinal behavior of carbohydrate antigen 19-9 in this patient population. We evaluated whether carbohydrate antigen 19-9 levels predict postoperative biliary complications or reflect concurrent biliary abnormalities during follow-up.
METHODS: We retrospectively analyzed 233 patients who underwent extrahepatic bile duct surgery for choledochal cyst or pancreaticobiliary maljunction without biliary dilatation and had at least 1 carbohydrate antigen 19-9 measurement. Longitudinal changes in log10-transformed carbohydrate antigen 19-9 levels were assessed using linear mixed-effects models with patient-specific random intercepts. Associations of carbohydrate antigen 19-9 levels with biliary classification and time-varying active biliary complications were also examined.
RESULTS: In total, 2,530 carbohydrate antigen 19-9 measurements were analyzed. Carbohydrate antigen 19-9 levels generally decreased after surgery, particularly after excluding the measurements obtained after the onset of biliary complications. In time-varying mixed-effects models, carbohydrate antigen 19-9 levels were significantly increased during active biliary complication periods (β = .130; P < .001), intrahepatic bile duct stone-positive periods (β = .126; P < .001), and asymptomatic intrahepatic bile duct stone-positive periods (β = .143; P < .001). Preoperative carbohydrate antigen 19-9 levels correlated with the Kato classification (P = .025) but not with the Todani classification (P = .427).
CONCLUSION: After choledochal cyst surgery, carbohydrate antigen 19-9 may function as a reactive biomarker associated with biliary stasis-related morphology and ongoing or occult biliary abnormalities rather than as a stand-alone predictor of future postoperative complications. Serial carbohydrate antigen 19-9 monitoring may provide useful adjunctive information for long-term imaging surveillance.
METHODS: We retrospectively analyzed 233 patients who underwent extrahepatic bile duct surgery for choledochal cyst or pancreaticobiliary maljunction without biliary dilatation and had at least 1 carbohydrate antigen 19-9 measurement. Longitudinal changes in log10-transformed carbohydrate antigen 19-9 levels were assessed using linear mixed-effects models with patient-specific random intercepts. Associations of carbohydrate antigen 19-9 levels with biliary classification and time-varying active biliary complications were also examined.
RESULTS: In total, 2,530 carbohydrate antigen 19-9 measurements were analyzed. Carbohydrate antigen 19-9 levels generally decreased after surgery, particularly after excluding the measurements obtained after the onset of biliary complications. In time-varying mixed-effects models, carbohydrate antigen 19-9 levels were significantly increased during active biliary complication periods (β = .130; P < .001), intrahepatic bile duct stone-positive periods (β = .126; P < .001), and asymptomatic intrahepatic bile duct stone-positive periods (β = .143; P < .001). Preoperative carbohydrate antigen 19-9 levels correlated with the Kato classification (P = .025) but not with the Todani classification (P = .427).
CONCLUSION: After choledochal cyst surgery, carbohydrate antigen 19-9 may function as a reactive biomarker associated with biliary stasis-related morphology and ongoing or occult biliary abnormalities rather than as a stand-alone predictor of future postoperative complications. Serial carbohydrate antigen 19-9 monitoring may provide useful adjunctive information for long-term imaging surveillance.