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Are Incidental Gallbladder Cancers Missed with a Selective Approach of Gallbladder Histology at Cholecystectomy?
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
Lund Univ, Sweden.
Ryhov Hosp, Sweden.
Eksjö Nässjö Hosp, Sweden.
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2018 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 4, p. 1092-1099Article in journal (Refereed) Published
Abstract [en]

Incidental gallbladder cancer (IGBC) is an unexpected finding when a cholecystectomy is performed upon a benign indication, and the use of routine or selective histological analysis of gallbladder specimen is still debated. The aim of this study was to investigate whether the proportion of submitted gallbladder specimens for pathological investigation influences the proportion of IGBC found, and what possible factors preoperatively or perioperatively could influence the selection process. All cholecystectomies between January 2007 and September 2014 registered in the Swedish Registry of Gallstone Surgery and ERCP (GallRiks) were included. Proportion of histological analysis was divided into four subgroups (0-25%, amp;gt; 25-50%, amp;gt; 50-75%, amp;gt; 75-100%). A total of 81,349 cholecystectomies were registered, and 36,010 (44.3%) gallbladder specimens were sent for histological analysis. A total of 213 cases of IGBC were discovered, which constituted 0.26% of all cholecystectomies performed and 0.59% of the number of gallbladder specimens sent for histological analysis. Hospitals submitting amp;gt; 75-100% of the gallbladder specimens had significantly more IGBC/1000 cholecystectomies performed (p = 0.003). Hospitals with the most selective approach had a significantly higher proportion of IGBC/1000 gallbladders that were sent for histological analysis (p amp;lt; 0.001). Factors such as higher age (p amp;lt; 0.001), female gender (p = 0.048) and macroscopic cholecystitis (p amp;lt; 0.001) were more common in gallbladder specimens from hospitals that had a selective approach to histological analysis. A routine approach to histological analysis in cholecystectomies with a benign indication for surgery can uncover a higher proportion of IGBC cases. When a selective approach is used, risk factors should be taken into account.

Place, publisher, year, edition, pages
SPRINGER , 2018. Vol. 42, no 4, p. 1092-1099
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-147095DOI: 10.1007/s00268-017-4215-0ISI: 000427050900023PubMedID: 28900706OAI: oai:DiVA.org:liu-147095DiVA, id: diva2:1199563
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2019-08-23
In thesis
1. Incidental Gallbladder Cancer: Incidence, predictors, management and outcome in a Swedish population
Open this publication in new window or tab >>Incidental Gallbladder Cancer: Incidence, predictors, management and outcome in a Swedish population
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cholecystectomy is a common surgical procedure and incidental gallbladder cancer is a rare and unexpected finding at a cholecystectomy performed upon benign indications. Whether to perform routine or selective histopathology of the gallbladder specimen is still a subject for discussion. The prognosis of gallbladder cancer is largely affected by tumour stage and treatment.

Aims: The overall aim was to study whether routine histological examination of the gallbladder specimen is of clinical and health economic value; determine if there are any predictive factors of incidental gallbladder cancer at benign cholecystectomy and compare the management and outcome of incidental gallbladder cancer patients in Sweden.

Methods: All studies were based on registry data from GallRiks (The Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography) between 2007 and 2016, with some modifications between studies. Complemental cross-linkage was made to national registries, and medical records were reviewed. Papers I, II and III were population-based observational studies with prospectively and retrospectively collected data. Paper IV was a health economic evaluation based on the results from papers I and III.

Results and conclusions: Hospitals submitting >75 per cent of gallbladder specimens diagnosed a higher proportion of incidental gallbladder cancer than did hospitals submitting ≤25 per cent of samples (paper I). Incidental gallbladder cancer was more prevalent in older patients, women and patients with acute or previous cholecystitis, as well as ongoing jaundice. The risk model based on predictive preoperative factors was further improved by adding a macroscopic assessment of the gallbladder (paper II). Predictive factors for gallbladder cancer appeared to have an impact on which specimens were submitted in hospitals with a selective approach of histopathology (paper I). For pT2 and pT3 patients, re-resection improved diseasespecific survival, although these groups differed in terms of age and comorbidity (paper III). Residual disease was an independent factor for impaired survival. A change to routine histopathology of gallbladder specimens in Sweden would lead to increased costs with little improved health outcomes. Instead, a more standardized approach to selective histology would be needed (paper IV).

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1695
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-159835 (URN)9789176850152 (ISBN)
Public defence
2019-09-27, Hasselqvistsalen, Hus 511, Campus US, Linköping, 09:00 (English)
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Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-08-23Bibliographically approved

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Lundgren, Linda

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