©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2016; 8(10): 685-692
Published online Oct 27, 2016. doi: 10.4240/wjgs.v8.i10.685
Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis?
Krashna Patel, Khaled Dajani, Satheesh Iype, Nikolaos A Chatzizacharias, Saranya Vickramarajah, Prateush Singh, Susan Davies, Rebecca Brais, Siong S Liau, Simon Harper, Asif Jah, Raaj K Praseedom, Emmanuel L Huguet
Krashna Patel, Khaled Dajani, Satheesh Iype, Nikolaos A Chatzizacharias, Prateush Singh, Siong S Liau, Simon Harper, Asif Jah, Raaj K Praseedom, Emmanuel L Huguet, Department of Surgery, Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge CB20XZ, United Kingdom
Saranya Vickramarajah, Department of Upper Gastrointestinal Surgery, Addenbrooke’s Hospital, Cambridge CB20XZ, United Kingdom
Susan Davies, Rebecca Brais, Department of Histopathology, Addenbrooke’s Hospital, Cambridge CB20XZ, United Kingdom
Author contributions: All the authors contribute to the manuscript.
Institutional review board statement: The study was reviewed and approved by the Hepatopancreatobiliary Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent at the time of the operation prior to the study.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email@example.com. Participants’ consent was not obtained for data sharing but the presented data are anonymized with no risk of identification.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emmanuel L Huguet, MD, PhD, Consultant Hepato-Pancreato-Biliary surgeon, Department of Surgery, Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Hills Road, Cambridge CB20XZ, United Kingdom. firstname.lastname@example.org
Telephone: +44-1223-257074 Fax: +44-1223-216015
Received: May 9, 2016
Peer-review started: May 11, 2016
First decision: June 14, 2016
Revised: August 4, 2016
Accepted: August 15, 2016
Article in press: August 16, 2016
Published online: October 27, 2016
To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.
Incidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine cholecystectomy. All cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively analysed. Further data was collected on all specimens demonstrating carcinoma, dysplasia and polypoid growths.
The study included 4027 patients. The majority (97%) of specimens exhibited gallstone or cholecystitis related disease. Polyps were demonstrated in 44 (1.09%), the majority of which were cholesterol based (41/44). Dysplasia, ranging from low to multifocal high-grade was demonstrated in 55 (1.37%). Incidental primary gallbladder adenocarcinoma was detected in 6 specimens (0.15%, 5 female and 1 male), and a single gallbladder revealed carcinoma in situ (0.02%). This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens, including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder malignancies.
Routine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.
Core tip: The selective use of histopahological examination of gallbladders removed during routine cholecystectomy has been advocated by several authors in the literature. We present a large single centre study demonstrating a full range of gallbladder disease from cholecystectomy specimens, including more than 1% neoplastic histology and two cases of microscopic gallbladder malignancies in macroscopically normal gallbladders. On this basis, routine histological evaluation of all elective and emergency cholecystectomies is justified in an United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.