• Vivian P Bastiaenen, Jaap L P van Vliet, Elise A J de Savornin Lohman, Bartholomeus J G A Corten, Joske de Jonge, Anne C Kraima, Hilko A Swank, van AckerGijs J DGJDDepartment of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands., van GelovenAnna A WAAWDepartment of Surgery, Tergooi Hospital, 1213 XZ Hilversum, The Netherlands., Klaas H In 't Hof, Lianne Koens, Philip R de Reuver, Charles C van Rossem, Gerrit D Slooter, Pieter J Tanis, Valeska Terpstra, DijkgraafMarcel G WMGWDepartment of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands., Willem A Bemelman, and Dutch Snapshot Research Group.
• Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
• Br J Surg. 2022 Mar 15; 109 (4): 355362355-362.

BackgroundThere is ongoing debate concerning the necessity of routine histopathological examination following cholecystectomy. In order to reduce the pathology workload and save costs, a selective approach has been suggested, but evidence regarding its oncological safety is lacking.MethodsIn this multicentre, prospective, cross-sectional study, all gallbladders removed for gallstone disease or cholecystitis were systematically examined by the surgeon for macroscopic abnormalities indicative of malignancy. Before sending all specimens to the pathologist, the surgeon judged whether histopathological examination was indicated. The main outcomes were the number of patients with hypothetically missed malignancy with clinical consequences (upper limit two-sided 95 per cent c.i. below 3:1000 considered oncologically safe) and potential cost savings of selective histopathological examination.ResultsTwenty-two (2.19:1000) of 10 041 specimens exhibited malignancy with clinical consequences. In case of a selective policy, surgeons would have held back 7846 of 10041 (78.1 per cent) gallbladders from histopathological examination. Malignancy with clinical consequences would have been missed in seven of 7846 patients (0.89:1000, upper limit 95% c.i. 1.40:1000). No patient benefitted from the clinical consequences, while two were harmed (futile additional surgery). Of 15 patients in whom malignancy with clinical consequences would have been diagnosed, one benefitted (residual disease radically removed), two potentially benefitted (palliative systemic therapy), and four experienced harm (futile additional surgery). Estimated cost savings established by replacing routine for selective histopathological examination were €703 500 per 10 000 patients.ConclusionSelective histopathological examination following cholecystectomy is oncologically safe and could reduce pathology workload, costs, and futile re-resections.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

12 keywords...

hide…