527 Selective Approach to Gallbladder Histopathological Examination Following Cholecystectomy. Would Incidental Gallbladder Cancers Be Missed?

Abstract

Abstract Background The incidental finding of gallbladder carcinoma on histopathological examination following cholecystectomy is rare and thus, a selective approach should be evaluated as it could be more cost-efficient. The primary aim of this retrospective study was to assess the incidence of gallbladder cancer in a single hospital trust. The secondary aim was to evaluate the predictive value of macroscopic changes. Method A retrospective analysis of all cholecystectomies performed at a hospital trust between November 2017-November 2019. Discharge notes, operation notes, histopathology reports were evaluated. Results In total, 966 patients were included. All gallbladder specimens had been sent for histopathological examination. The histology was normal in 21 patients (2.1%) and inflammatory changes reported in 930 cases (96.3%). Gallbladder dysplasia was found in 14 specimens (1.5%) and macroscopic abnormalities were seen in 11 of those. One case (0.1%) was reported as incidental gallbladder carcinoma and macroscopic abnormalities were observed intra-operatively. Conclusions Gallbladder carcinoma detected incidentally after cholecystectomy is rare. Gallbladder dysplasia and cancer are associated with macroscopic abnormalities and thus selective approach could potentially replace routine histopathological examination - provided all gallbladders are dissected and inspected at the time of surgery.