Aboutaleb E*, Saleh F, Pore N, Raje D, Mitropoulos G and Sheth H
Department of General Surgery, Ealing Hospital, London North West Trust, UKFulltext PDF
Background: 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. Methods: 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. Results: 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 gallbladder cancer. All cases of malignant disease were identified by the surgeon intraoperatively on gross inspection. The cost of routine histopathological analysis was ?128 per patient. Conclusion: 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 labor cost saving.
Aboutaleb E, Saleh F, Pore N, Raje D, Mitropoulos G, Sheth H. Routine Histopathology for Resected Gallbladder Specimens: Outcomes and Cost-Benefit Analysis at a District General Hospital, Retrospective Cohort Study. Clin Surg. 2020; 5: 3001..