j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 1 9 6 e2 0 1
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Selective histology of cholecystectomy specimensdis it justified? Yi-lei Deng, MD, Xian-ze Xiong, MD, Yong Zhou, MD, Anuj Shrestha, MD, Fu-yu Li, MD, and Nan-sheng Cheng, MD* Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
article info
abstract
Article history:
Background: Gallbladder cancer (GBC) is rare but the most common malignancy of biliary
Received 20 December 2013
tract with a dismal prognosis. The early diagnosis and surgical treatment of GBC offers the
Received in revised form
only chance of long-term survival. Despite advances in radiological imaging, early diag-
12 July 2014
nosis of GBC is still rarely achieved without histopathology. In our hospital, routine his-
Accepted 18 July 2014
tologic examination of all resected gallbladder specimens has been standard practice. This
Available online 24 July 2014
study seeks to define whether selective histologic examination for gallbladder specimens based on preoperative imaging or intraoperative findings is justified.
Keywords:
Materials and methods: From September 2008eSeptember 2013, all histopathology reports of
Gallbladder cancer
gallbladder specimens after elective cholecystectomy were retrospectively analyzed in a
Histopathology
single surgical unit. Preoperative imaging, intraoperative findings, and histology notes
Cholecystectomy
were analyzed in all cases. Results: Out of 14,369 (60% female and 40% male) patients undergoing cholecystectomy, GBC was found in only 46 cases (0.32%). More than one fifth (10/46) of GBC patients presented with acute cholecutitis (AC). All 10 AC patients coexisted with GBC harbored “significantly inflamed’ gallbladders, and about 83.49% AC patients were judged with “significant inflammation.” Carcinoma in situ and early GBC (T1a, T1b) accounted for 61% of all cases. Only two patients with Tis and T1a respectively did not show suspicious lesion on preoperative and intraoperative findings, but for the remaining cases (44/46), GBC was suspected either by preoperative imaging and/or intraoperative findings. Conclusions: Almost all cases of invasive GBC will show macroscopic abnormalities following examination by a simple procedureda full dissection, inspection, and palpation of the gallbladder. Any patient with early GBCs “missed” on macroscopic examination can still receive the appropriate treatment by the cholecystectomy alone. The gallbladder should be sent for histology only if macroscopic examination raises suspicion. This selective policy is more cost-effective, and does not appear to compromise patients outcome. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
In general surgery, cholecystectomy is the most common operative procedure performed worldwide. An average of 7e8
patients per day underwent cholecystectomy in our hospital in the last 5 y. It has been standard practice to submit all resected gallbladder specimens for routine histologic examination postoperatively, regardless of whether or not there is
* Corresponding author: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. Tel.: þ86 28 85422465; fax: þ86 28 85422468. E-mail address: [email protected] (N.-s. Cheng). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.07.039
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 1 9 6 e2 0 1
any grossly visible abnormalities. The main purpose of the histopathologic analysis is to reveal if any other additional pathologies, especially unexpected gallbladder cancer (GBC) is present. GBC is rare but the most common malignancy of biliary tract with a dismal prognosis, with a median survival of only 3 mo, and a 5-y survival rate of
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Selective histology of cholecystectomy specimensdis it justified? Yi-lei Deng, MD, Xian-ze Xiong, MD, Yong Zhou, MD, Anuj Shrestha, MD, Fu-yu Li, MD, and Nan-sheng Cheng, MD* Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
article info
abstract
Article history:
Background: Gallbladder cancer (GBC) is rare but the most common malignancy of biliary
Received 20 December 2013
tract with a dismal prognosis. The early diagnosis and surgical treatment of GBC offers the
Received in revised form
only chance of long-term survival. Despite advances in radiological imaging, early diag-
12 July 2014
nosis of GBC is still rarely achieved without histopathology. In our hospital, routine his-
Accepted 18 July 2014
tologic examination of all resected gallbladder specimens has been standard practice. This
Available online 24 July 2014
study seeks to define whether selective histologic examination for gallbladder specimens based on preoperative imaging or intraoperative findings is justified.
Keywords:
Materials and methods: From September 2008eSeptember 2013, all histopathology reports of
Gallbladder cancer
gallbladder specimens after elective cholecystectomy were retrospectively analyzed in a
Histopathology
single surgical unit. Preoperative imaging, intraoperative findings, and histology notes
Cholecystectomy
were analyzed in all cases. Results: Out of 14,369 (60% female and 40% male) patients undergoing cholecystectomy, GBC was found in only 46 cases (0.32%). More than one fifth (10/46) of GBC patients presented with acute cholecutitis (AC). All 10 AC patients coexisted with GBC harbored “significantly inflamed’ gallbladders, and about 83.49% AC patients were judged with “significant inflammation.” Carcinoma in situ and early GBC (T1a, T1b) accounted for 61% of all cases. Only two patients with Tis and T1a respectively did not show suspicious lesion on preoperative and intraoperative findings, but for the remaining cases (44/46), GBC was suspected either by preoperative imaging and/or intraoperative findings. Conclusions: Almost all cases of invasive GBC will show macroscopic abnormalities following examination by a simple procedureda full dissection, inspection, and palpation of the gallbladder. Any patient with early GBCs “missed” on macroscopic examination can still receive the appropriate treatment by the cholecystectomy alone. The gallbladder should be sent for histology only if macroscopic examination raises suspicion. This selective policy is more cost-effective, and does not appear to compromise patients outcome. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
In general surgery, cholecystectomy is the most common operative procedure performed worldwide. An average of 7e8
patients per day underwent cholecystectomy in our hospital in the last 5 y. It has been standard practice to submit all resected gallbladder specimens for routine histologic examination postoperatively, regardless of whether or not there is
* Corresponding author: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. Tel.: þ86 28 85422465; fax: þ86 28 85422468. E-mail address: [email protected] (N.-s. Cheng). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.07.039
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 1 9 6 e2 0 1
any grossly visible abnormalities. The main purpose of the histopathologic analysis is to reveal if any other additional pathologies, especially unexpected gallbladder cancer (GBC) is present. GBC is rare but the most common malignancy of biliary tract with a dismal prognosis, with a median survival of only 3 mo, and a 5-y survival rate of
