Clinicopathological features and prognosis of surgical resected cases of biliary cancer with pancreaticobiliary maljunction

To the Editor:Pancreaticobiliary maljunction(PBM)is a congenital anomaly in which the pancreatic and bile ducts join anatomically outside of the duodenal wall away from the Oddi’s sphincter.This condition causes the reflux of pancreatic juice into the bile duct under high pressure,resulting in various pathologic changes.The features of PBM patients are common bile duct dilatation,long common channel,and high amylase levels in bile juice.Among them,one of the most significant problems is the development of biliary cancer,including extrahepatic bile duct and gallbladder cancers[1].A nationwide survey in Japan reported biliary cancer in 21.6%of adult patients with PBM concomitant with congenital biliary dilatation,32.1%and 62.3%extrahepatic bile duct and gallbladder cancers,respectively[2].