Surgical inspection of the gallbladder in relation to final pathology outcome

Corten, B.J.G.A.; Alexander, S; Zwam, Peter van; Leclercq, Wouter K G; Roumen, R. M. H.; Slooter, Gerrit D.

doi:10.1016/j.ejso.2018.10.243

Cited by 2 publications

(10 citation statements)

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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%

“…Three studies 23,28,52 (5633 patients) from countries with a low incidence of GBC in which the surgeon systematically inspected the gallbladder mucosa were included in the subgroup analysis. This resulted in an incidence of truly incidental GBC of 0·04 (95 per cent c.i.…”

Section: Resultsmentioning

confidence: 99%

“…Opponents of a selective policy fear that surgeons might not identify these abnormalities, and argue that the macroscopic examination should be performed by a pathologist who is more experienced in recognizing aberrant findings suspicious for GBC. In a prospective study comparing macroscopic gallbladder examination performed by surgeons and pathologists, Corten and colleagues 52 found strong agreement between both types of assessor (κ = 0·822). Surgeons and pathologists disagreed on only 18 of 319 gallbladder specimens, and no cancer was found in any of these 52 .…”

Section: Discussionmentioning

confidence: 97%

“…In a prospective study comparing macroscopic gallbladder examination performed by surgeons and pathologists, Corten and colleagues 52 found strong agreement between both types of assessor (κ = 0·822). Surgeons and pathologists disagreed on only 18 of 319 gallbladder specimens, and no cancer was found in any of these 52 . Similarly, in a prospective study by Romero‐González and co‐workers 28 , surgeons were asked to evaluate the risk of GBC based on clinical risk factors and macroscopic assessment.…”

Section: Discussionmentioning

confidence: 97%

“…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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Section: Incidence Of Truly Incidental Gallbladder Cancermentioning

confidence: 99%

See 3 more Smart Citations

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

Bastiaenen

Tuijp

Besselink

et al. 2020

British Journal of Surgery

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Method for adequate macroscopic gallbladder examination after cholecystectomy

Corten

Leclercq

Zwam

et al. 2020

Acta Chirurgica Belgica

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Background and aims: There is no clear guideline nor protocol for macroscopic examination of the gallbladder, leaving surgeons extemporaneous in regard of gallbladder examination in selective histopathologic policy. The purpose of this article is to describe a surgical approach for adequate macroscopic inspection of the gallbladder. Materials and methods: The described practical method was developed in collaboration between surgeons and pathologists. This method was introduced in 2011 and implemented in 2012. We retrospectively reviewed the number of cholecystectomies and number of histopathologic examinations between 2006 and 2017, using our own patient database. We used the Netherlands Cancer Registry (NCR) to examine the incidence of gallbladder cancer patients before and after implementation of the selective policy in our hospital. In addition to the method, we depict several frequent macroscopic abnormalities in order to provide some examples for surgical colleagues. Results: Since implementation of the selective policy, 2271 surgical macroscopic gallbladder examinations were performed. As a result, we observed a significant decrease from 83% in 2012 to 38% in 2017, in histopathologic examination of the gallbladder following cholecystectomy. We observed a stable trend of gallbladder carcinoma in the same period (0.17%, n ¼ 4 during 2006-2011 and 0.26%, n ¼ 6 during 2012-2017). Conclusion: A simple, valid and easy method is described for future macroscopic analysis by the surgeon following a cholecystectomy.

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Surgical inspection of the gallbladder in relation to final pathology outcome

Cited by 2 publications

References 0 publications

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

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

Method for adequate macroscopic gallbladder examination after cholecystectomy

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