Importance of Routine Histopathology of Gallbladder after Elective Cholecystectomy for Gallstones

Abstract

Introduction:  Gallstones are the hard deposits in the gallbladder, which is a sac – like organ lying on the inferior surface of liver in the right upper quadrant of abdomen. Cholecystectomy is the first line surgical procedure to manage symptomatic gallstone. Carcinoma gallbladder carries worst prognosis of all cancer mortality and seen in patients with chronic cholecystitis due to cholelithiasis. The purpose of conducting

this study was to highlight the fact, that the histopathology of the gallbladder in Pakistan is only restricted to those specimens, which are associated with macroscopic abnormalities.

Objective:  The frequency of gallbladder carcinoma in routine histopathology after elective Cholecystectomy for gallstones who did not show any macroscopic findings preoperatively.

Material and Methods:  This cross sectional study of 250 patients of both gender aged between 18 – 60 years was conducted in surgical OPD/North Surgical Unit of Mayo Hospital, Lahore in one year duration from 01-01-2014 to 31-12-2014. The non-probability purposive sampling technique was used in this study. Informed consent was taken from all the patients. Their demographics like name, age, gender and address were noted. Open / laparoscopic cholecystectomy was performed depending upon patient’s choice. All gallbladder specimens, those with no obvious gross abnormalities were sent for histopathology (Gross findings, histopathological diagnosis). All data was recorded on a pre-designed proforma and analyzed using SPSS version 20. Mean and standard deviation were used to express the continuous variables like age, stone size and duration of disease. All qualitative variables like gender, number of stones and gallbladder carcinoma were presented in the form of frequency and percentages. Stratification was done for duration of disease, number of stone, size of stone and gender to address effect modifiers. Post stratification chi-square test was applied keeping P-value ≤ 0.05 as significant.

Results:  In this study the mean age of the patients was 39.52 ± 12.38 years. Among 250 patients, 75 (30%) were males and 175 (70%) females. The mean duration of disease was 5.61 ± 2.75 months. Gallbladder carcinoma on routine histopathology after elective Cholecystectomy was observed in 18 (7.2%) patients whereas 232 (92.8%) patients did not have gallbladder carcinoma. All of the 18 patients who had carcinoma were females which showed a highly significant difference (p < 0.05). Among 153 cases with < 7 mm stone size, carcinoma was observed in 11 patients and in 97 cases with ≥ 7 mm stone size, carcinoma was observed in 7 cases. Among 124 cases with < 5 months of duration of disease, carcinoma was observed in 9 patients and in 126 cases with ≥ 5 months of duration of dis-ease, carcinoma was observed in 9 cases. Among 93 cases with < 2 stones, carcinoma was observed in 7 patients and in 157 cases with ≥ 2 stones, carcinoma was observed in 11 cases. Statistically insignificant difference was found between the duration of disease, number and size of stones and carcinoma of the patients (P > 0.05).

Conclusion:  Although the frequency of gallbladder carcinoma on histopathology is low, but not negligible, therefore histopathology of gallbladder specimen is necessary to rule out carcinoma.