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.


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.


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

Article published online:
01 February 2021

© 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. (

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  • References

  • 1 Halldestam I, Enell EL, Kullman E, Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 2004; 91 (06) 734-738
  • 2 Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 2006; 93 (02) 158-168
  • 3 Elwood DR. Cholecystitis. Surg Clin North Am 2008; 88 (06) 1241-1252 , viii
  • 4 Cancer Research UK. Gallbladder cancer incidence statistics. . Available at: Accessed May 20, 2019
  • 5 Levy AD, Murakata LA, Rohrmann Jr CA. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics 2001; 21 (02) 295-314 , questionnaire 549–55
  • 6 Sujata J, Rana S, Khan S, Hassan MJ, Jairajpuri ZS. Incidental gall bladder carcinoma in laparoscopic cholecystectomy: a report of 6 cases and a review of the literature. J Clin Diagn Res 2013; 7 (01) 85-88
  • 7 Antonakis P, Alexakis N, Mylonaki D. et al. Incidental finding of gallbladder carcinoma detected during or after laparoscopic cholecystectomy. Eur J Surg Oncol 2003; 29 (04) 358-360
  • 8 Cavallaro A, Piccolo G, Di Vita M. et al. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg 2014; 12 (Suppl. 02) S108-S119
  • 9 Royal College of Pathologists, Histopathology and cytopathology of limited or no clinical value. Available at: Accessed April 18, 2019
  • 10 van Vliet JL, van Gulik TM, Verbeek PC. Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination. Dig Surg 2013; 30 (4-6): 472-475
  • 11 Emmett CD, Barrett P, Gilliam AD, Mitchell AI. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl 2015; 97 (07) 526-529
  • 12 Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1998. CA Cancer J Clin 1998; 48 (01) 6-29
  • 13 Eslick GD. Epidemiology of gallbladder cancer. Gastroenterol Clin North Am 2010; 39 (02) 307-330 , ix
  • 14 Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 2006; 118 (07) 1591-1602
  • 15 Wang YC, Wei LJ, Liu JT, Li SX, Wang QS. Comparison of cancer incidence between China and the USA. Cancer Biol Med 2012; 9 (02) 128-132
  • 16 Lohsiriwat V, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg 2009; 33 (10) 2189-2193
  • 17 Crawford JM. The liver and biliary tract. In: Cotran RS, Kumar V, Collins T. eds. Pathological Basis of Disease. Philadelphia, PA: Saunders; 1999: 899
  • 18 Rao RV, Kumar A, Sikora SS, Saxena R, Kapoor VK. Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma. Trop Gastroenterol 2005; 26 (01) 31-33
  • 19 Adson M. Advances in Diagnosis and Treatment of Biliary Tract Disease. New York, NY: Masson; 1983
  • 20 Varshney S, Butturini G, Gupta R. Incidental carcinoma of the gallbladder. Eur J Surg Oncol 2002; 28 (01) 4-10
  • 21 Lai CH, Lau WY. Gallbladder cancer--a comprehensive review. Surgeon 2008; 6 (02) 101-110
  • 22 You DD, Lee HG, Paik KY, Heo JS, Choi SH, Choi DW. What is an adequate extent of resection for T1 gallbladder cancers?. Ann Surg 2008; 247 (05) 835-838
  • 23 Clemente G. Unexpected gallbladder cancer: Surgical strategies and prognostic factors. World J Gastrointest Surg 2016; 8 (08) 541-544
  • 24 Gagner M, Rossi RL. Radical operations for carcinoma of the gallbladder: present status in North America. World J Surg 1991; 15 (03) 344-347
  • 25 Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA. Carcinoma of the gallbladder. Does radical resection improve outcome?. Arch Surg 1990; 125 (02) 237-241
  • 26 Pearlstone DB, Curley SA, Feig BW. The management of gallbladder cancer: before, during, and after laparoscopic cholecystectomy. Semin Laparosc Surg 1998; 5 (02) 121-128
  • 27 Kapoor VK, Pradeep R, Haribhakti SP, Sikora SS, Kaushik SP. Early carcinoma of the gallbladder: an elusive disease. J Surg Oncol 1996; 62 (04) 284-287
  • 28 Roa I, Araya JC, Villaseca M, Roa J, de Aretxabala X, Ibacache G. Gallbladder cancer in a high risk area: morphological features and spread patterns. Hepatogastroenterology 1999; 46 (27) 1540-1546
  • 29 Shrestha R, Tiwari M, Ranabhat SK, Aryal G, Rauniyar SK, Shrestha HG. Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimens. Nepal Med Coll J 2010; 12 (02) 90-94