252 Incidental Gall Bladder Cancer in Patients Underwent Cholecystectomy: Do We Need Selective Histological Examination of the Gallbladder Following Cholecystectomy?

Abstract

Abstract Background This study evaluated the incidence of incidental gall bladder cancer in patients undergoing cholecystectomy using the selective histological examination of the gallbladder following cholecystectomy operation (S-GALLOP). In return, the study assessed the value of S-GALLOP in patients undergoing cholecystectomy and the factors that can prompt histological examination. Method The present retrospective chart review retrieved the records of 3710 consecutive patients who underwent elective or emergency cholecystectomy due to benign pathologies at through 10-year period. Results 80.7% of the patients were chronic cholecystitis,6.3% were acute cholecystitis, 1.9% were gallbladder and 1% were gallbladder cholesterolosis. Six cases had incidental GBC (incidence rate = 0.0016%). All patients were females, except two patients, who underwent elective cholecystectomy. The median age 60.5 (range 55 to 70) . The preoperative ultrasound showed multiple gallbladder stones and thickened gallbladder wall in most of these six patients. Four patients had moderately differentiated adenocarcinoma, one had well-differentiated adenocarcinoma, and one had poorly differentiated adenocarcinoma with metastasis. On the other hand, 23 cases had gallbladder dysplasia (incidence rate = 0.006%). The median age was 61 (35 – 73), and 82.3% of the patients were females. Only three cases underwent an emergency procedure. Only one patient had high-grade dysplasia, aged 71 years old. Conclusions Incidence GBC is rare in patients undergoing elective or emergency cholecystectomy. Thus, histological examination for all cases is not recommended and S-GALLOP can represent a cost-effective alternative. S-GALLOP is recommended for any gallbladder specimen that seems abnormal on macroscopic examination, especially in old age and patients with suspicious preoperative imaging findings.