Role of Detailed Intraoperative Macroscopic Examination of Cholecystectomy Specimens for Deciding Specimens Needing Histological Evaluation for Diagnosing Incidental Carcinoma of Gallbladder at the Earliest? A Systematic Review

Abstract

Background: Several studies recommending selective or routine histopathological examination of gallbladder specimens have been done. However, the argument between these studies is based on intraoperative suspicion of IGBC (incidental gallbladder carcinoma) for deciding on specimen sending. This study aims to know whether a detailed intraoperative examination of cholecystectomy specimens is required for deciding on specimens needing histological evaluation and suspecting IGBCs at the earliest. Methodology: The systematic review has been done as per the PRISMA guidelines. Various articles were searched in Scopus, PubMed, Web of Science and Science Direct databases. This systematic review comprises studies involving patients diagnosed with benign gallbladder disease that underwent cholecystectomy but were later diagnosed with IGBC on routine or selective histological examination. Results: Out of the 26 studies that were chosen, 12 recommended routine histopathology and 14 recommended selective histopathology. The total number of gallbladders included in these studies was 79769, and the IGBCs diagnosed on histology were 494. The gross macroscopy of IGBCs diagnosed in routine histology recommending studies overlapped with the intraoperative macroscopic picture of the IGBCs diagnosed in selective histology recommending studies based on which the surgeons suspected them, thereby showing a need for detailed intraoperative macroscopic examination of gallbladders to avoid overlooking any IGBC. Conclusion: Detailed intraoperative examination of cholecystectomy specimens is essential for suspecting IGBCs at the earliest and for selective histopathology, as in its absence, a significant number of IGBCs are missed by surgeons. Keywords: cholecystectomy, pathology, gallbladder, carcinoma