K Jamal1, K Ratansingham2, M Siddique3, D Nehra4. 1. Epsom and St Helier's Hospital, Surrey, United Kingdom. Electronic address: karim@jamal.uk.com. 2. Epsom and St Helier's Hospital, Surrey, United Kingdom. Electronic address: kumaran95@hotmail.com. 3. Epsom and St Helier's Hospital, Surrey, United Kingdom. Electronic address: md0u812a@zoho.com. 4. Epsom and St Helier's Hospital, Surrey, United Kingdom. Electronic address: Dhiren.Nehra@esth.nhs.uk.
Abstract
BACKGROUND: 70,000 cholecystectomies were performed in the United Kingdom in 2011-2012. Currently it is standard practice to submit all gallbladder specimens for routine histology to exclude malignancy. The aim of this systematic review was to establish whether a normal macroscopic appearance to the gallbladder at the time of cholecystectomy is sufficient to rule out malignancy and therefore negate the need for routine histology. METHODS: Relevant articles that were published between 1966 and January 2013 were identified through electronic databases. RESULTS: 21 studies reported on 34,499 histologically analysed specimens. 172/187 (92%) of gallbladder cancers demonstrated intra-operative macroscopic abnormality. Studies that opened the specimens intra-operatively identified all cancers, whereas gross macroscopic visualization resulted in 15 potentially missed cancers (p = 0.10). In patients of European ethnicity, gallbladder cancer in a macroscopically normal looking gallbladder was identified in only one study; however all of these patients were above the age of 60. The incidence of gallbladder cancer was significantly raised in ethnic groups from high risk areas (p = 0.0001). CONCLUSIONS: A macroscopically normal gallbladder in patients of European ethnicity under the age of 60 may not require formal histopathology. The best method for intra-operative examination may involve opening the specimen to allow inspection of the mucosa and wall, however this needs further investigation. In the context of the volume of gallbladder surgery being performed there is the potential for significant cost and time savings.
BACKGROUND: 70,000 cholecystectomies were performed in the United Kingdom in 2011-2012. Currently it is standard practice to submit all gallbladder specimens for routine histology to exclude malignancy. The aim of this systematic review was to establish whether a normal macroscopic appearance to the gallbladder at the time of cholecystectomy is sufficient to rule out malignancy and therefore negate the need for routine histology. METHODS: Relevant articles that were published between 1966 and January 2013 were identified through electronic databases. RESULTS: 21 studies reported on 34,499 histologically analysed specimens. 172/187 (92%) of gallbladder cancers demonstrated intra-operative macroscopic abnormality. Studies that opened the specimens intra-operatively identified all cancers, whereas gross macroscopic visualization resulted in 15 potentially missed cancers (p = 0.10). In patients of European ethnicity, gallbladder cancer in a macroscopically normal looking gallbladder was identified in only one study; however all of these patients were above the age of 60. The incidence of gallbladder cancer was significantly raised in ethnic groups from high risk areas (p = 0.0001). CONCLUSIONS: A macroscopically normal gallbladder in patients of European ethnicity under the age of 60 may not require formal histopathology. The best method for intra-operative examination may involve opening the specimen to allow inspection of the mucosa and wall, however this needs further investigation. In the context of the volume of gallbladder surgery being performed there is the potential for significant cost and time savings.
Authors: B J G A Corten; S Alexander; P H van Zwam; W K G Leclercq; R M H Roumen; G D Slooter Journal: J Gastrointest Surg Date: 2018-08-21 Impact factor: 3.452
Authors: V P Bastiaenen; J E Tuijp; S van Dieren; M G Besselink; T M van Gulik; L Koens; P J Tanis; W A Bemelman Journal: Br J Surg Date: 2020-07-08 Impact factor: 6.939