ThP6.3 - Is routine histopathological analysis required following cholecystectomy? Free

To identify incidental gall bladder cancers (IGBC) in elective cholecystectomy specimen. Preoperative presentations were observed to see if a selective approach can be adopted when requesting histopathological examination (HPE) following elective cholecystectomy.

Retrospective data was gathered for all patients undergoing cholecystectomy in 2022 at a single university teaching hospital. Histology reports and preoperative presentations were analysed. The total sample size was 505.

Within the 505 patients, six operations did not occur, and five other patients underwent pancreaticojejunostomy. In the remaining 494 patients who underwent successful cholecystectomy 130 were males. Two (0.4%) patients were found to have IGBC (poorly differentiated adenocarcinoma). Both were females aged 57 and 75 years with grossly thickened gall bladder at operation. One patient underwent portal lymphadenectomy and segmental liver resection whilst the other patient was commenced on palliative chemotherapy.

We found very low incidence of IGBC following routine elective cholecystectomy. This is particularly rare in young patients (< 50 years) found to have a thin-walled gallbladder on ultrasound examination or at laparoscopy. Hence routine HPE following elective cholecystectomy does not seem necessary. We recommend requesting HPE if any mucosal abnormality is identified on inspecting the specimen after removal or if the gallbladder is thick-walled at laparoscopy or preoperative imaging, or patient is over 50 years of age. In the absence of level 1 evidence, such a pragmatic approach appears safe, cost-effective, and offers good use of valuable resources.