Should we perform surgical management in all patients with suspected porcelain gallbladder?

Porcelain gallbladder has generally been regarded as a risk factor for gallbladder cancer. This study was designed to clarify the association between porcelain gallbladder and cancer by analysis of clinicopathological features of patients who underwent surgery for suspected porcelain gallbladder.

From January 2002 to December 2008, 3159 cholecystectomies were performed at Ajou University Medical Center. Twelve patients were preoperatively diagnosed with suspected porcelain gallbladder. To examine the association between gallbladder calcification and cancer, patients who were histopathologically diagnosed with either gallbladder calcification or cancer were also reviewed.

According to final pathology, 44.3% of patients showed porcelain gallbladder. During the study period, calcification of gallbladder wall was identified in 9 patients (0.2%). The mean age was 54.6 +/- 15.0 years (range, 30-75). The female-to-male ratio was 3.5:1. However, preoperative porcelain gallbladder was diagnosed in 5 patients. Eight of 9 patients underwent LC, whereas the remaining one patient underwent laparoscopic-assisted distal gastrectomy. Interestingly, there was no patient with a diagnosis of both porcelain gallbladder and cancer.

We found that preoperative diagnosis of porcelain gallbladder was difficult. Moreover, there was no association between porcelain gallbladder and cancer. Therefore, when porcelain gallbladder is suspected, surgeons should decide operation, based on the symptoms rather than the possibility of coexistence of gallbladder cancer.