Routine versus selective histologic analysis of gallbladder specimens for the detection of incidental gallbladder cancers. A retrospective review over 9 years of activity with a special focus on patients' age

Elshaer, Mohamed; Gravante, Gianpiero; Yang, Yifan; Hudson, Sarah; Thomas, K. Bryn; Sorge, Roberto; Al-Hamali, Salem; Kelkar, Ashish; Ebdewi, Hamdi

doi:10.1016/j.amjsurg.2013.12.038

Cited by 15 publications

(16 citation statements)

References 16 publications

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“…There has been a concern about the presence of early GBC in a normal-looking gallbladder specimen. However, simple cholecystectomy is considered adequate in these patients, and no further therapy is required (8,(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Routine histopathological examination of gallbladder specimens after cholecystectomy: Is it time to change the current practice?

et al. 2019

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Objective: Routine histopathological examination of all gallbladder specimens, regardless of the clinical characteristics of the patient or macroscopic aspect of the gallbladder, is the current approach to detect the presence of gallbladder carcinoma. The aim of the present study was to assess whether or not it would be safe to adopt a policy of processing only gallbladder specimens with preoperative or intraoperative suspicion for malignancy without compromising patient safety. Material and Methods: From January 2009 to June 2017, all histopathology reports of 3423 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed in two university hospitals. Results: A total of 3423 gallbladder specimens submitted for histopathological examination during the study period were included into the study. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 2792 (81.6%), acute cholecystitis in 237 (6.9%), and cholesterolosis in 223 (6.5%) patients. Dysplasia was found in 5 (0.14%) patients, and gallbladder carcinoma was detected in 4 (0.11%) patients. All patients with gallbladder carcinoma were diagnosed either preoperatively or intraoperatively, and none of the patients with gallbladder carcinoma were diagnosed from the histopathological examination. Conclusion: A strategy of selective approach for histopathological examination of gallbladder specimens may be safe in areas with very low incidence of gallbladder carcinoma. Such selective strategy is more cost-effective, reduces the workload of pathologists, and does not appear to compromise patient outcome.

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Section: Discussionmentioning

confidence: 99%

Routine histopathological examination of gallbladder specimens after cholecystectomy: Is it time to change the current practice?

et al. 2019

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“…10,11 We describe an alternative approach to subjecting every cholecystectomy specimen to histological examination. However, surgeons wishing to adopt this approach should be cautious and exercise careful judgement in deciding whether to send a specimen.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] Studies suggest high risk groups include older patients, patients converted from laparoscopic to open surgery, female patients, patients of Asian and African ethnicity, and patients with raised alkaline phosphatase levels prior to surgery. 10,11 Other studies advocate routine histological examination of all specimens as the safest approach. 5,12,13 In view of this disagreement in the literature, our study sought to determine the frequency of IGBC in our institution and to establish whether selective histological examination of macroscopically abnormal specimens only would have detected these cancers.…”

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confidence: 99%

Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma

Barrett

Gilliam

et al. 2015

annals

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Introduction Gallstone disease is treated commonly with cholecystectomy. Malignant disease of the gallbladder may present similarly and has a poor prognosis. It is common for cholecystectomy specimens to be sent for histological examination to exclude malignancy. However, the incidence of incidental gallbladder carcinoma (IGBC) is low and it has therefore been suggested that macroscopic inspection of the gallbladder by the surgeon, followed by selective histological examination of abnormal specimens, may be safe and cost saving. Methods All cholecystectomies performed between 1 May 2003 and 1 September 2009 were identified from clinical coding. Pathology records were used to identify gallbladder malignancies; these were searched manually to identify IGBC. Pathology reports and case notes were cross-referenced to determine whether there were macroscopic abnormalities present. Annual cost savings were estimated by comparing the number of gallbladder specimens over one year (May 2013 – April 2014) with the total number of cholecystectomies performed in that time. Results Of 4,776 cholecystectomies identified, 12 (0.25%) were cases of IGBC. These cases had a higher median age (68 vs 54 years, p<0.001) and a higher proportion were emergency operations (50% vs 12%, p<0.001). All cases had some form of macroscopic abnormality, most commonly wall thickening (n=6, 50%). Only two cases (17%) had a visible tumour present. Conclusions All cases of IGBC in this study had a macroscopically abnormal gallbladder. Our findings suggest it is safe to adopt a selective approach to histological examination. Savings of almost £20,500 per annum have been achieved.

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“…Original Downloaded From: https://jamanetwork.com/ on 06/09/2020 low-up data were available for patients undergoing SC in the studies examined. The rare incidence of incidental GB cancer, 63 combined with the fact that SC is limited to select patients, reduces the possibility of GB carcinoma developing in the GB remnant. Therefore, the necessity of a completion cholecystectomy to prevent the development of GB cancer is unlikely.…”

Section: Subtotal Cholecystectomymentioning

confidence: 99%

Subtotal Cholecystectomy for “Difficult Gallbladders”

et al. 2015

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Routine versus selective histologic analysis of gallbladder specimens for the detection of incidental gallbladder cancers. A retrospective review over 9 years of activity with a special focus on patients' age

Cited by 15 publications

References 16 publications

Routine histopathological examination of gallbladder specimens after cholecystectomy: Is it time to change the current practice?

Routine histopathological examination of gallbladder specimens after cholecystectomy: Is it time to change the current practice?

Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma

Subtotal Cholecystectomy for “Difficult Gallbladders”

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