Introduction Biliary cystadenoma (BCA) are rare, benign, potentially malignant cystic lesions of the liver, accounting for less than 5% of cystic liver tumours. These lesions have potential for recurrence and malignant transformation. The aim of the study was to analyse the outcome following resection of biliary cystadenoma from a single tertiary centre.

Method Patients who had resection of BCA between 1993 and 2014 (21 years) were included in the study. The data were obtained form a prospectively maintained liver surgical and pathological database. Patient demographics, clinico-pathological characteristics, operative data and post-operative outcome were collected.

Results 29 patients had surgery for BCA. Median age was 62 (IQ 48–74) years and the Male:Female ratio was 28:1. The main clinical presentation was abdominal pain (74%) followed by jaundice (20%), abdominal mass (14%) and deranged LFTs (3%). On pre-operative imaging, single cyst was seen in 76% of patients. The majority of cysts were found at central location (48%). Cyst characteristics included septations (48%), wall thickening (31%), wall irregularity (38%), papillary projections (10%) and mural nodule (3%). Surgical procedures performed as follows: atypical liver resection (45%), left hemihepatectomy (34%), right hemihepatectomy (10%), excision of extra hepatic bile duct (7%) and left lateral segmentectomy (3%). Three patients had de-roofing for suspected simple liver cyst, which were confirmed on histology as biliary cystadenoma. All had re-resection with clear margins. Median length of stay was 7 (IQ 6.5 – 8.5) days. 2 patients developed bile leak, one each managed conservatively and with ERCP. There was no peri-operative mortality. None of the patients had evidence of malignancy on final histology. Median follow-up was 11 (IQ 2–44) months. One patient developed delayed biliary stricture requiring reconstruction. One died 11 years later due to development of inoperable cholangiocarcinoma.

Disclosure of interest None Declared.

Conclusion Biliary cystadenomas can be resected safely with significantly low morbidity. Malignant transformation and recurrence are rare. Complete surgical resection provides a cure.