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Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma
C D Emmett1, P Barrett1, A D Gilliam1
1County Durham and Darlington NHS Foundation Trust , UK.
Annals of the Royal College of Surgeons of England
|August 15, 2015
Summary
Selective histological examination of gallbladder specimens after cholecystectomy may be safe and cost-effective. All incidental gallbladder carcinomas (IGBC) identified had visible macroscopic abnormalities, suggesting a targeted approach is feasible.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Oncology
Background:
- Cholecystectomy is a common procedure for gallstone disease.
- Gallbladder malignancies can mimic benign conditions, necessitating histological examination.
- Incidental gallbladder carcinoma (IGBC) is rare, prompting cost-saving strategies.
Purpose of the Study:
- To evaluate the safety and cost-effectiveness of selective histological examination of cholecystectomy specimens.
- To determine if macroscopic inspection by surgeons can reliably identify gallbladders requiring histological analysis for malignancy.
Main Methods:
- Retrospective review of 4,776 cholecystectomies performed between May 2003 and September 2009.
- Identification of IGBC through pathology records and cross-referencing with clinical notes.
- Analysis of macroscopic abnormalities in relation to IGBC presence.
- Estimation of annual cost savings based on specimen numbers and total procedures.
Main Results:
- 12 cases (0.25%) of IGBC were identified.
- IGBC cases were associated with higher median age and emergency operations.
- All IGBC cases exhibited macroscopic abnormalities, predominantly wall thickening.
- Visible tumors were present in only 17% of IGBC cases.
Conclusions:
- Macroscopic abnormalities in the gallbladder are consistently present in IGBC.
- A selective histological examination approach based on macroscopic findings appears safe.
- Implementing this strategy could lead to significant cost savings, estimated at nearly £20,500 annually.
