Importance of routine histopathological examination of a gallbladder surgical specimen

Background Unexpected gallbladder cancer (UGBC) is sometimes found in the resected gallbladder of patients during or after surgery. Some reports have indicated UGBC identification rates for all gallbladder surgeries, but scarce data are available for the UGBC identification rates for specific gallbladder diseases. The present study was performed to clarify UGBC rates and the factors suspicious for UGBC categorized according to preoperative diagnoses, in patients undergoing laparoscopic cholecystectomy (LSC). Methods We recorded data for all LSC surgeries performed in the Department of Surgery, Sada Hospital, Japan since 1991, and analyzed the 28-year data. We used the chi-square test and Kaplan-Meier analysis for this retrospective case-control study. Results The UGBC identification rate was 0.69% (63/9186 patients). The UGBC identification rates categorized according to the preoperative diagnoses were 1.3% (13/969) for acute cholecystitis, 2.4% (16/655) for benign tumor, 2.0% (28/1383) for chronic cholecystitis or cholecystitis, and 0.054% (3/5585) for cholecystolithiasis. The percentage of older patients (� 60 years) was significantly higher in UGBCs compared with cases finally diagnosed as benign in each group categorized according to the preoperative diagnoses (p�0.0014), except for cholecystolithiasis. In cases pre-diagnosed as benign tumor, UGBCs were associated with higher rates of thickened gallbladder wall compared with benign tumor (69.2% vs. 27.9%, respectively; p = 0.0011). UGBCs pre-diagnosed as acute cholecystitis had higher T2-T4 rates (100% vs. 64.3%, respectively; p<0.05) and lower survival rates (p = 0.0149) than UGBCs pre-diagnosed with chronic cholecystitis. Conclusions UGBC identification rates depend on the preoperative diagnosis and range from 0.054% to 2.4%. Older age (� 60 years) could be related to UGBC, and a pre-diagnosis of acute

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“…detection rate was 0.25%-1.0% [4,15,16,20]. Our UGBC identification rate was low compared with the rates in these studies.…”

Section: Plos Onecontrasting

confidence: 73%

Preoperative diagnoses and identification rates of unexpected gallbladder cancer

Fujiwara¹,

Masatsugu²,

Abe³

et al. 2020

PLoS ONE

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“…An additional 18 studies were identified during manual cross‐referencing, resulting in a total of 73 articles, including 232 155 patients, that were eligible for data analysis. These studies were then divided into those performed in countries with a low incidence (39) 6,18–55 and countries with a high incidence (34) 7,56–88 of GBC. Characteristics of all included studies are presented in Table S1 (supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…5). Three studies 23,28,52 (5633 patients) from countries with a low incidence of GBC in which the surgeon systematically De Zoysa et al 20 Almuslamani et al 22 Genç et al 23 Ghimire et al 24 Byars and Pursnani 25 Cavallaro et al 26 Chin et al 27 Romero-González et al 28 Bawahab et al 29 De Werra et al 30 Ferrarese et al 31 Koshenkov et al 32 Ozgur et al 33 Panebianco et al 34 Elshaer et al 35 Ghnnam et al 36 van Vliet et al 6 Amiraslanov et al 37 Bali et al 38 Emmett et al 39 Lilic et al 40 Basak et al 41 Düzköylü et al 43 Patel et al 44 Al-Qahtani et al 45 Tatli et al 46 Uysal et al 47 Wrenn et al 48 Al Manasra et al 49 Benkhadoura et al 50 Charfi et al 51 Corten et al 52 Dincel et al 53 Geramizadeh et al 54 Olthof et al 55 456 of 129 059 Total Heterogeneity:…”

Section: Incidence Of Truly Incidental Gallbladder Cancermentioning

confidence: 99%

Safe, selective histopathological examination of gallbladder specimens: a systematic review

Bastiaenen

Tuijp

Besselink

et al. 2020

British Journal of Surgery

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Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.

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“…Regarding the most affected gender, it is possible to observe in a statistically significant manner that females have higher incidence in both surgical procedures, as shown in the study by Ishak et al 13 , in which gallbladder cancer has represented, among women, a 79% rate. Dincel et al 1 , in their research, have shown that females have a four times higher frequency of gallbladder cancer when compared to males. The study by Salazar et al 14…”

Section: Discussionmentioning

confidence: 94%

“…G allbladder cancer is a rare tumor with high mortality rates. It is the cancer that occurs in the bile ducts with the lowest median survival at the time of diagnosis, the most common bile duct cancer, and the fifth most common among gastrointestinal cancers 1,2 .…”

Section: Introductionmentioning

confidence: 99%

Incidência comparativa de câncer incidental de vesícula biliar em colecistectomias de urgência versus colecistectomias eletivas.

Figueiredo

Santos²,

Paula

2019

Rev. Col. Bras. Cir.

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RESUMO Objetivo: analisar, comparativamente, a incidência de câncer incidental de vesícula biliar em colecistectomias de urgência versus colecistectomias eletivas realizadas em hospitais públicos de Teresina-PI. Métodos: estudo observacional descritivo, quantitativo, com delineamento transversal, cujo cenário foram dois hospitais públicos de Teresina-PI. Foram analisados 6.329 prontuários de pacientes submetidos à colecistectomia, entre janeiro de 2011 e dezembro de 2017. Os dados coletados foram divididos em dois grupos e confrontados estatisticamente através do teste Z para diferença entre proporções. Resultados: detectou-se câncer incidental da vesícula biliar em 6,53% das colecistectomias de urgência e em 0,38% das eletivas. Quanto ao sexo, observou-se que, na cirurgia de urgência, 69% eram mulheres e 31%, homens, enquanto no procedimento eletivo, 78% eram mulheres e 22%, homens. Quanto à idade, a maioria dos pacientes possuía mais de 60 anos e, entre estes, 69,3% submetidos à colecistectomias de urgência e 82,6%, à eletivas. O tipo histopatológico "adenocarcinoma" foi encontrado em 84,6% das cirurgias de urgência e 100% das eletivas. Conclusão: câncer incidental de vesícula biliar foi mais frequente em colecistectomias de urgência em comparação às eletivas. O perfil dos pacientes com essa doença maligna nos dois tipos de procedimento foi do sexo feminino, maiores de 60 anos de idade e com diagnóstico histopatológico de adenocarcinoma.

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Importance of routine histopathological examination of a gallbladder surgical specimen

Cited by 18 publications

References 24 publications

Preoperative diagnoses and identification rates of unexpected gallbladder cancer

Preoperative diagnoses and identification rates of unexpected gallbladder cancer

Safe, selective histopathological examination of gallbladder specimens: a systematic review

Incidência comparativa de câncer incidental de vesícula biliar em colecistectomias de urgência versus colecistectomias eletivas.

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