CC BY 4.0 · Surg J (N Y) 2021; 07(01): e22-e25
DOI: 10.1055/s-0040-1722175
Original Article

Incidental Gallbladder Cancer: Routine versus Selective Histological Examination After Cholecystectomy

1  Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
,
2  School of Medicine, Imperial College London, United Kingdom
,
Nikhil Pawa
1  Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
,
Shakir Karim
3  Department of Histopathology, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
,
Jason Smith
1  Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
› Author Affiliations
Funding There is no funding or sponsorship for this article.

Abstract

Background Incidental gallbladder cancer is relatively rare, with an incidence ranging between 0.19 and 5.5% of all the cholecystectomies for benign disease, and carries a poor prognosis. Currently, in the literature, there appears to be some controversy about whether all gallbladder specimens should be sent for routine histopathology. The aim of this study was to investigate the need for either routine or selective histopathological evaluation of all gallbladder specimens following cholecystectomy in our institution.

Methods The records of all patients who underwent a cholecystectomy (laparoscopic and open) for gallstone disease over a 5-year period (between January 2011 and January 2016) were reviewed retrospectively in a single university teaching hospital. Patients with radiological evidence of gallbladder cancer preoperatively were excluded. The notes of patients with incidental gallbladder cancer were reviewed and data were collected for clinical presentation and preoperative investigations including blood tests and radiological imaging.

Results A total of 1,473 specimens were sent for histopathological evaluation, with two patients being diagnosed with an incidental gallbladder cancer (papillary adenocarcinoma in situ and moderately differentiated invasive adenocarcinoma [stage IIIa]). The incidence rate was 0.14%. All patients with incidental gallbladder cancer had macroscopically abnormal specimens.

Conclusion Both patients in our study who were diagnosed with incidental gallbladder cancer had macroscopic abnormalities. A selective rather than routine approach to histological evaluation of gallbladder specimens especially in those with macroscopic abnormalities should be employed. This will reduce the burden on the pathology department with potential cost savings.

Note

The study has been approved by me and my coauthors, as well as by the responsible authorities at the hospital in which this work has been performed. I certify that none of the material has been published previously and is not currently under consideration for publication elsewhere. The coauthors (A. D. A., N. P., S. K., and J. S.) confirm that they qualify for coauthorship according to the Uniform Requirements for Manuscripts published in the guidelines of the International Committee of Medical Journal Editors in 1988.




Publication History

Received: 25 July 2019

Accepted: 16 September 2020

Publication Date:
01 February 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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