Routine Examination of Gallbladder Specimens after Cholecystectomy: Analysis of the Incidence, Clinical and Histopathological aspects of incidental gallbladder carcinoma

Abstract

Purpose: Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy – this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. Method: Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-Test and ANOVA. Results: Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in 6 cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease – 73.7 ± 5.38 years vs 55.8 ± 0.79 years (p<0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage – one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression – median survival was 7 months (range 2-14). Conclusion: In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.TP01.04_Table. Characteristics of patients with Incidental Gallbladder CancerPatientGenderAgeIndication of surgeryGBaGallbladder on preoperative imagingHistopathologyAJCCcAmerican Joint Committee on Cancer StageTreatmentAliveSurvival (months)1M53Biliary colicThick-walledCCbChronic CholecystitisIISurgeryY172F80PancreatitisThick-walledCCbChronic CholecystitisIVAChemotherapyN23F80CholangitisNormalCCbChronic Cholecystitis + DysplasiaIVAN74F72Biliary colicNormalCCbChronic CholecystitisIIIBChemotherapyN75F66CholangitisNormalDysplasiaIVAChemotherapyN146F91Biliary colicAdenomyomatosisCCbChronic Cholecystitis + DysplasiaIIIAY23a Gallbladderb Chronic Cholecystitisc American Joint Committee on Cancer Open table in a new tab