All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer

Traditionally, a gallbladder removed for presumed benign disease has been sent for histopathological examination (HPE), but this practice has been the subject of controversy. This study was undertaken to compare patients in whom gallbladder cancer (GBC) was diagnosed after cholecystectomy on HPE with GBC patients in whom the gallbladder was not sent for HPE and who therefore presented late with symptoms.

A retrospective analysis of prospectively collected data for 170 GBC patients diagnosed after cholecystectomy was conducted. All patients presented to one centre during 2000-2011. These patients were divided into two groups based on the availability of histopathology reports: Group A included patients who presented early with HPE reports (n = 93), and Group B comprised patients who presented late with symptoms and without HPE reports (n = 77).

The median time to presentation in Group A was significantly lower than in Group B (29 days vs. 152 days; P < 0.001). Signs or symptoms suggestive of recurrence (pain, jaundice or gastric outlet obstruction) were present in four (4.3%) patients in Group A and all (100%) patients in Group B (P < 0.001). Patients deemed operable on preoperative evaluation included all (100%) patients in Group A and 38 (49.4%) patients in Group B (P < 0.0001). The overall resectability rate (69.9% vs. 7.8%) and median survival (54 months vs. 10 months) were significantly higher in Group A compared with Group B (P < 0.0001).

Patients in whom a cholecystectomy specimen was sent for HPE presented early, had a better R0 resection rate and longer overall survival. Hence, routine HPE of all cholecystectomy specimens should be performed.