‘Routine’ pathological examination of the gallbladder is a futile exercise

Ann R Coll Surg Engl 2007; 89: 238-241 238Adenocarcinoma of the gall bladder is a rare but aggressive gastrointestinal malignancy. It carries a dismal prognosis, with a reported overall 5-year survival rate not exceeding 5%.1 According to a large multicentre survey commissioned by the French Surgical Association, the overall median survival is just 3 months, 2 the main reason being late presentation. It mainly affects patients in their 7th and 8th decade and is about 5 times more common in females. It is estimated that in 85% of cases it is associated with gallstones 3 but the only recognised pre-malignant condition is a 'porcelain gall bladder'. In the vast majority of patients who are diagnosed with gall bladder carcinoma, the first suspicion of malignancy arises during operation and is confirmed on histological examination of the specimen. Despite advances in radiological imaging, accurate preoperative diagnosis is the exception rather than the rule. At present, all specimens, regardless of their macroscopic appearance, are being sent for histological examination. It seems questionable whether the result of the histopathological examination of each gall bladder would alter management when it provides no advantage to the surgeon, patient or pathologist.The aim of the study was to assess the necessity of routine histological examination of the gall bladder following simple cholecystectomy and its impact on the further management of the patients. Patients and MethodsWe analysed, retrospectively, the electronic database of histological reports of all gall bladder specimens after cholecystectomy in the last 5 years. In all cases of confirmed malignancy, we retrieved and reviewed, from patients notes and, when missing, from the hospital electronic database, results of pre-operative investigations such as: liver function tests, ultrasound scans or computed tomography Gall bladder carcinoma is a rare malignancy that carries a very poor prognosis. Laparoscopic cholecystectomy (LC) is established as the gold-standard treatment for symptomatic gall stones. The aim of the study was to assess the incidence of gall bladder carcinoma and the possibility of reducing the routine histological examination of gall bladder specimens.

Section: Discussionmentioning

confidence: 99%

Is there Any Justification for the Routine Histological Examination of Straightforward Cholecystectomy Specimens?

Darmas

Mahmud

Abbas

et al. 2007

“…5,6,8,11,12,17,18,24,26,27 Their second argument is that even early GBMs (stage I, pT1), which may appear normal in macroscopy, do not warrant further treatment as cholecystectomy iself may be curative. 5,6 Other non-clinical reasons for recommending selective histology include the unnecessary cost and time spent on specimen processing and evaluation by the histopathologists on normal looking gallbladders during routine histology.…”

Section: Selective Evaluationmentioning

confidence: 99%

Histological assessment of cholecystectomy specimens performed for symptomatic cholelithiasis: routine or selective?

Jayasundara

Silva

2013

Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise.

“…In 1998, Taylor and Huang discussed how routine pathological examination of gallbladder is pointless: they proposed selective evaluation according to macroscopic examination. 5 In 2003, Dix and colleagues approved the same approach, and stated that routine histopathological evaluation of gallbladder specimens provides no favourable service to the patient, surgeon, or pathologist. 6 In 2007,…”

mentioning

confidence: 99%

“…1,4 Simple cholecystectomy can be regarded as adequate treatment of all benign and early malignant T1 gallbladder lesions. 5 Therefore, additional therapeutic interventions besides simple cholecystectomy are not necessary. If preoperative imaging or perioperative exploration of the gallbladder can be used to identify suspicious or malignant diseases early, then histopathological evaluation of such specimens would be valuable.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases

Başak

Hasbahçeci

Canbak

et al. 2016

INTRODUCTION Cholecystectomy for benign gallbladder diseases can lead to previously undiagnosed gallbladder cancer during histopathological evaluation. Despite some controversy over its usefulness, histopathological evaluation of all gallbladder specimens is common in most hospitals. We evaluated the results of routine pathology of the gallbladder after cholecystectomy for benign gallbladder diseases with regard to unexpected primary gallbladder cancer (UPGC). METHODS Patients undergoing cholecystectomy because of benign gallbladder diseases between 2009 and 2013 were enrolled in this study. All gallbladder specimens were sent to the pathology department, and histopathological reports were examined in detail. The impact of demographic features on pathological diagnoses and prevalence of UPGC assessed. Data on additional interventions and postoperative survival for patients with UPGC were collected. RESULTS We enrolled 1,747 patients (mean age, 48.7±13.6 years). Chronic cholecystitis was the most common diagnosis (96.3%) and was associated significantly with being female (p=0.001). Four patients had UPGC (0.23%); one was stage T3 at the time of surgery, and the remaining three cases were stage T2. CONCLUSIONS Routine histopathological examination of the gallbladder is valuable for identification of cancer that requires further postoperative management.