Archive
Volume 9 , Issue 4 , August 2021 , Pages: 51 - 54
Routine Histopathology for Resected Gallbladder Specimens: Outcomes and Cost-benefit Analysis at a District General Hospital, Retrospective Cohort Study
Aboutaleb Esam, General Surgery Department, Ealing Hospital, London North West Trust, London, UK
Saleh Fatima, General Surgery Department, Ealing Hospital, London North West Trust, London, UK
Pore Naresh, General Surgery Department, Ealing Hospital, London North West Trust, London, UK
Raje Durgesh, General Surgery Department, Ealing Hospital, London North West Trust, London, UK
Mitsopoulos Grigos, General Surgery Department, Ealing Hospital, London North West Trust, London, UK
Sheth Hemant, General Surgery Department, Ealing Hospital, London North West Trust, London, UK
Received: Jun. 21, 2021;       Accepted: Jul. 2, 2021;       Published: Jul. 15, 2021
DOI: 10.11648/j.sr.20210904.12        View        Downloads  
Abstract
Routine histopathological assessment of resected gallbladder specimens is a common practice in the UK. However, the incidence of incidental gallbladder cancer is low and there is a debate over whether selective histopathology is more appropriate. Here we aim to identify the incidence of malignant and pre-malignant disease upon routine histological analysis of gallbladder specimens in Ealing hospital. We conducted a retrospective analysis of gallbladder histopathology reports was performed for all patients undergoing cholecystectomy at Ealing Hospital between June 2011 and December 2018. Demographic information, operative findings, pathology results, staging, treatment and outcome information were collected for each case of malignant or pre-malignant disease. The total financial cost of histopathological analysis of resected specimens was calculated. A total of 1,612 patients underwent cholecystectomy with histopathological assessment of the resected specimen. The majority of specimens showed chronic cholecystitis 71.3%. Acute cholecystitis 28.1%. Gall bladder polyps found in two patients 0.12%. Low grade dysplasia was identified in three patients 0.19% while high grade dysplasia was identified in two patients 0.12%, and malignant disease was reported in three patients 0.19%, two patients had stage 2 and one had stage 3 gall bladder cancer. All cases of malignant disease were identified by the surgeon intra-operatively on gross inspection. The cost of routine histopathological analysis was £128 per patient. The incidence of pre-malignant or malignant gallbladder disease after cholecystectomy is rare. A selective approach to histopathological assessment, based on patient age, clinical presentation and intra-operative findings, will provide a financial and labour cost saving.
Keywords
Gallbladder, Histopathology, Cost
To cite this article
Aboutaleb Esam, Saleh Fatima, Pore Naresh, Raje Durgesh, Mitsopoulos Grigos, Sheth Hemant, Routine Histopathology for Resected Gallbladder Specimens: Outcomes and Cost-benefit Analysis at a District General Hospital, Retrospective Cohort Study, Science Research. Vol. 9, No. 4, 2021, pp. 51-54. doi: 10.11648/j.sr.20210904.12
Copyright
Copyright © 2021 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[ 1 ]
Patel K, Dajani K, Iype S, Chatzizacharias NA, Vickramarajah S, Singh P, et al. Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis? World J Gastrointest Surg. United States; 2016 Oct; 8: 685–692.
[ 2 ]
Siddiqui FG, Memon AA, Abro AH, Sasoli NA, Ahmad L. Routine histopathology of gallbladder after elective cholecystectomy for gallstones: waste of resources or a justified act? BMC Surg. England; 2013 Jul; 13: 26.
[ 3 ]
Basak F, Hasbahceci M, Canbak T, Sisik A, Acar A, Yucel M, et al. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases. Ann R Coll Surg Engl. England; 2016 Apr; 98: 280–283.
[ 4 ]
Dincel O, Goksu M, Hatipoglu HS. Importance of routine histopathological examination of a gallbladder surgical specimen: Unexpected gallbladder cancer. J Cancer Res Ther. India; 2018; 14: 1325–1329.
[ 5 ]
Wrenn SM, Callas PW, Abu-Jaish W. Histopathological examination of specimen following cholecystectomy: Are we accepting resect and discard? Surg Endosc. Germany; 2017 Feb; 31: 586–593.
[ 6 ]
Lundgren L, Muszynska C, Ros A, Persson G, Gimm O, Valter L, et al. Are Incidental Gallbladder Cancers Missed with a Selective Approach of Gallbladder Histology at Cholecystectomy? World J Surg. United States; 2018 Apr; 42: 1092–1099.
[ 7 ]
Kalita D, Pant L, Singh S, Jain G, Kudesia M, Gupta K, et al. Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy - a study of 4,115 cholecystectomy specimens. Asian Pac J Cancer Prev. Thailand; 2013; 14: 3315–3318.
[ 8 ]
Koppatz H, Nordin A, Scheinin T, Sallinen V. The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens. HPB (Oxford). England; 2018 May; 20: 456–461.
[ 9 ]
Emmett CD, Barrett P, Gilliam AD, Mitchell AI. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl. England; 2015 Oct; 97: 526–529.
[ 10 ]
Dorobisz T, Dorobisz K, Chabowski M, Pawlowski W, Janczak D, Patrzalek D, et al. Incidental gallbladder cancer after cholecystectomy: 1990 to 2014. Onco Targets Ther. New Zealand; 2016; 9: 4913–4916.
[ 11 ]
Choi KS, Choi SB, Park P, Kim WB, Choi SY. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: a systematic review and meta-analysis. World J Gastroenterol. United States; 2015 Jan; 21: 1315–1323.
[ 12 ]
Hayes BD, Muldoon C. Seek and ye shall find: the importance of careful macroscopic examination and thorough sampling in 2522 cholecystectomy specimens. Ann Diagn Pathol. United States; 2014 Jun; 18: 181–186.
[ 13 ]
Hari DM, Howard JH, Leung AM, Chui CG, Sim M-S, Bilchik AJ. A 21-year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate? HPB (Oxford). England; 2013 Jan; 15: 40–48.
[ 14 ]
Ethun CG, Le N, Lopez-Aguiar AG, Pawlik TM, Poultsides G, Tran T, et al. Pathologic and Prognostic Implications of Incidental versus Nonincidental Gallbladder Cancer: A 10-Institution Study from the United States Extrahepatic Biliary Malignancy Consortium. Am Surg. United States; 2017 Jul; 83: 679–686.
[ 15 ]
Soreide K, Guest R V, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg. England; 2019 Jan; 106: 32–45.
[ 16 ]
Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg. United States; 1994 Mar; 219: 275–280.
[ 17 ]
Wistuba II, Miquel JF, Gazdar AF, Albores-Saavedra J. Gallbladder adenomas have molecular abnormalities different from those present in gallbladder carcinomas. Hum Pathol. 1999; 30 (1): 21.
[ 18 ]
Said K, Glaumann H, Bergquist A. Gallbladder disease in patients with primary sclerosing cholangitis. J Hepatol. 2008; 48 (4): 598.
[ 19 ]
Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014; 6: 99. Epub 2014 Mar 7
[ 20 ]
2Chijiiwa K, Kimura H, Tanaka M. Malignant potential of the gallbladder in patients with anomalous pancreaticobiliary ductal junction. The difference in risk between patients with and without choledochal cyst. Int Surg. 1995; 80 (1): 61.
[ 21 ]
Butte JM, Matsuo K, Gonen M, D’Angelica MI, Waugh E, Allen PJ, et al. Gallbladder cancer: differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. J Am Coll Surg. United States; 2011 Jan; 212: 50–61.
[ 22 ]
Jamal K, Ratansingham K, Siddique M, Nehra D. Routine histological analysis of a macroscopically normal gallbladder--a review of the literature. Int J Surg. England; 2014; 12: 958–962.
[ 23 ]
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C and Mathew G, for the STROCSS Group. The STROCSS 2019 Guideline: Strenthening the Reporting of Cohort Studies in Surgery. International Journal of Surgery 2019; 72: 156-165.
Browse journals by subject