Selective histological examination after cholecystectomy; an analysis of current daily practice in the Netherlands

Corten, B.J.G.A.; Leclercq, Wouter K G; Dejong, C. H. C.; Roumen, R.M.H.; Slooter, Gerrit D.

doi:10.1016/j.hpb.2020.04.121

Cited by 2 publications

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“…Moreover, if no macroscopic abnormalities are present, the cancer is usually of early stage and without clinical consequence, as the previously performed cholecystectomy suffices. In 2014, the Dutch guideline for gallstone disease was updated, proposing selective histopathological examination after cholecystectomy 8 , but implementation was suboptimal 9 . Less than half of hospitals adopted the selective strategy, and the need for more evidence on safety was expressed.…”

Section: Introductionmentioning

confidence: 99%

Safe, selective histopathological examination of gallbladder specimens: a systematic review

Bastiaenen

Tuijp

Besselink

et al. 2020

British Journal of Surgery

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Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.

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Section: Introductionmentioning

confidence: 99%

Safe, selective histopathological examination of gallbladder specimens: a systematic review

Bastiaenen

Tuijp

Besselink

et al. 2020

British Journal of Surgery

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“…An analysis of the current Dutch guidelines in all Dutch hospitals learns that half of the hospitals have implemented a Sel-HP [23]. Still 65% of gallbladders are sent for histopathologic examination while this number could be reduced to as low as 17-23% [2,23]. To date, adjustment of the Dutch guideline did not result in the expected decline of histopathologic gallbladder examinations nationwide [24].…”

Section: Discussionmentioning

confidence: 99%

Method for adequate macroscopic gallbladder examination after cholecystectomy

Corten

Leclercq

Zwam

et al. 2020

Acta Chirurgica Belgica

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Background and aims: There is no clear guideline nor protocol for macroscopic examination of the gallbladder, leaving surgeons extemporaneous in regard of gallbladder examination in selective histopathologic policy. The purpose of this article is to describe a surgical approach for adequate macroscopic inspection of the gallbladder. Materials and methods: The described practical method was developed in collaboration between surgeons and pathologists. This method was introduced in 2011 and implemented in 2012. We retrospectively reviewed the number of cholecystectomies and number of histopathologic examinations between 2006 and 2017, using our own patient database. We used the Netherlands Cancer Registry (NCR) to examine the incidence of gallbladder cancer patients before and after implementation of the selective policy in our hospital. In addition to the method, we depict several frequent macroscopic abnormalities in order to provide some examples for surgical colleagues. Results: Since implementation of the selective policy, 2271 surgical macroscopic gallbladder examinations were performed. As a result, we observed a significant decrease from 83% in 2012 to 38% in 2017, in histopathologic examination of the gallbladder following cholecystectomy. We observed a stable trend of gallbladder carcinoma in the same period (0.17%, n ¼ 4 during 2006-2011 and 0.26%, n ¼ 6 during 2012-2017). Conclusion: A simple, valid and easy method is described for future macroscopic analysis by the surgeon following a cholecystectomy.

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Selective histological examination after cholecystectomy; an analysis of current daily practice in the Netherlands

Cited by 2 publications

References 0 publications

Safe, selective histopathological examination of gallbladder specimens: a systematic review

Safe, selective histopathological examination of gallbladder specimens: a systematic review

Method for adequate macroscopic gallbladder examination after cholecystectomy

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