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Surgically Resected Gall Bladder: Is Histopathology Needed for All?


Affiliations
1 Department of Surgery, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
2 Department of Family & Community Medicine, College of Medicine, King Faisal University, Saudi Arabia
3 Department of Obstetrics and Gynecology, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
4 Department of Emergency, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
5 Mind and Brain Serviceline, Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi, Pakistan
 

Background: Laparoscopic cholecystectomy is considered to be gold standard for symptomatic gall stones. As a routine every specimen is sent for histopathological examination postoperatively. Incidentally finding gall bladder cancers in those specimens is around 0.5-1.1%. The aim of this study is to identify those preoperative and intraoperative factors in patients with incidental gall bladder cancer to reduce unnecessary work load on pathologist and cost of investigation particularly in a developing world. Methods: Retrospective records were analyzed from January 2005 to February 2015 in a surgical unit. Demographic data, preoperative imaging, peroperative findings, macroscopic appearance, and histopathological findings were noted. Gall bladder wall was considered to be thickened if ≥3mmon preoperative imaging or surgeons comment (on operative findings) and histopathology report. AJCC TNMsystem was used to stage gall bladder cancer. Results: 973 patients underwent cholecystectomy for symptomatic gallstone disease. Gallbladder carcinoma was incidentally found in 11 cases. Macroscopic abnormalities of the gallbladder were found in all those 11 patients. In patients with a macroscopically normal gallbladder, there were no cases of gallbladder carcinoma. Conclusion: Preoperative and operative findings play a pivotal role in determining incidental chances of gall bladder malignancy.
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  • Surgically Resected Gall Bladder: Is Histopathology Needed for All?

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Authors

Vikash Talreja
Department of Surgery, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
Aun Ali
Department of Surgery, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
Rabel Khawaja
Department of Family & Community Medicine, College of Medicine, King Faisal University, Saudi Arabia
Kiran Rani
Department of Obstetrics and Gynecology, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
Sunil Sadruddin Samnani
Department of Emergency, Jinnah Medical College Hospital, S. R-6, 7/A, Korangi Industrial Area, Karachi-74900, Pakistan
Farah Naz Farid
Mind and Brain Serviceline, Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi, Pakistan

Abstract


Background: Laparoscopic cholecystectomy is considered to be gold standard for symptomatic gall stones. As a routine every specimen is sent for histopathological examination postoperatively. Incidentally finding gall bladder cancers in those specimens is around 0.5-1.1%. The aim of this study is to identify those preoperative and intraoperative factors in patients with incidental gall bladder cancer to reduce unnecessary work load on pathologist and cost of investigation particularly in a developing world. Methods: Retrospective records were analyzed from January 2005 to February 2015 in a surgical unit. Demographic data, preoperative imaging, peroperative findings, macroscopic appearance, and histopathological findings were noted. Gall bladder wall was considered to be thickened if ≥3mmon preoperative imaging or surgeons comment (on operative findings) and histopathology report. AJCC TNMsystem was used to stage gall bladder cancer. Results: 973 patients underwent cholecystectomy for symptomatic gallstone disease. Gallbladder carcinoma was incidentally found in 11 cases. Macroscopic abnormalities of the gallbladder were found in all those 11 patients. In patients with a macroscopically normal gallbladder, there were no cases of gallbladder carcinoma. Conclusion: Preoperative and operative findings play a pivotal role in determining incidental chances of gall bladder malignancy.