Safe, selective histopathological examination of gallbladder specimens: a systematic review. Issue 11 (8th July 2020)

• Record Type: Journal Article
• Authors: Bastiaenen, V. P.; Tuijp, J. E.; van Dieren, S.; Besselink, M. G.; van Gulik, T. M.; Koens, L.; Tanis, P. J.; Bemelman, W. A.
• Is Part Of: British journal of surgery. Volume 107:Issue 11(2020)
• Page Start: 1414
• Page End: 1428
• Publication Date: 2020-07-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11759
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract : Background: Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods: A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results: Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion: Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs. Abstract : This meta‐analysis found that the incidence of truly incidental gallbladder cancer (GBC) was less than 0·5 per cent and decreased to less than 0·1 per cent when the surgeon performed a systematic macroscopic examination. At least 50 per cent of GBC that was not detected before or during surgery was of early stage and with no clinical consequences. Particularly in non‐endemic regions, selective histopathological examination after initital macroscopic assessment of the gallbladder by the surgeon seems safe and will likely result in significant cost and time savings. Open and palpate it Abstract : Antecedentes: El examen histopatológico rutinario después de la colecistectomía es caro y la prevalencia de cáncer de vesícula biliar ( gallbladder cancer, GBC) no sospechado o incidental es baja. Este estudio determinó si el examen histológico selectivo es seguro. Métodos: Se realizó una búsqueda exhaustiva en PubMed, Embase, Web of Science y en la Biblioteca Cochrane. Se estimaron las incidencias agrupadas de GBC incidental y realmente incidental (GBC detectado durante el examen histopatológico sin sospecha previa o intraoperatoria) utilizando un modelo de efectos aleatorios. Además, se evaluaron las consecuencias clínicas del GBC realmente incidental. Resultados: Se incluyeron 73 estudios ( n = 232.155). En los países de baja incidencia, la incidencia agrupada fue de 0, 32% para el GBC incidental (i.c. del 95% 0, 25 a 0, 42) y de 0, 18% (0, 10 a 0, 35) para GBC realmente incidental. El análisis de subgrupos que incluye estudios en los que los cirujanos examinaron sistemáticamente la vesícula biliar reveló una incidencia agrupada de 0, 04% (0, 01 a 0, 14). En los países de alta incidencia, las incidencias agrupadas correspondientes fueron 0, 83% (0, 58 a 1, 18), 0, 44% (0.2 a 0.91) y 0, 08% (0, 02 a 0, 39), respectivamente. Se describieron consecuencias clínicas en 176 (39, 3%) de 448 pacientes con GBC realmente incidental. Treinta y tres pacientes (18, 6%) se sometieron a cirugía secundaria. El análisis por subgrupos mostró que al menos la mitad de los GBC no detectados durante el examen sistemático de la vesícula biliar por parte del cirujano eran tumores de estadio precoz (≤ T1a) y sin consecuencias clínicas. Conclusión: El examen histológico selectivo de vesículas biliares después de la evaluación macroscópica inicial realizada por el cirujano parece seguro y podría reducir los costes.