Is systematic histological examination of the cholecystectomy specimen always necessary?

• Published in: Journal of visceral surgery Vol. 161; no. 1; pp. 33 - 40
• Main Authors: Slim, Karem, Badon, Flora, Darcha, Camille, Regimbeau, Jean-Marc
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.02.2024; Elsevier
• Subjects: Cancer; Cholecystectomy; Female; Gallbladder cancer; Gallbladder Diseases - surgery; Gallbladder lithiasis; Gallbladder Neoplasms - diagnosis; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Humans; Laparoscopy; Life Sciences; Pathological examination; Reproducibility of Results; Retrospective Studies; Cholecystectomy; Gallbladder lithiasis; Laparoscopy; Pathological examination; Gallbladder cancer
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2023.11.011

•The prevalence of incidentally discovered gallbladder cancer (GBC) is approximately 0.5% in the West, justifying, for many, systematic histological examination (HE) of the resected specimen.•Some authors advocate a policy of selective HE based on macroscopic examination of the opened gallbladder by the surgeon in the operating room. HE is then requested only in case of doubt or suspicion of incidentally-discovered cancer.•This selective attitude is not indicated in the presence of pre-operative factors (advanced age, female gender, acute cholecystitis, gallbladder polyp, calcified gallbladder) or intra-operative factors suggesting the existence of GBC.•According to recent data, the reliability of macroscopic examination is 100%. Cancers not detected by macroscopic examination in the operating room are early-stage pTis or pT1a cancers curable by simple cholecystectomy.•A pre-requisite for this policy is the rigorous macroscopic examination (manual and visual) of the gallbladder wall and mucosa by the surgeon before deciding to send the specimen for HE. The quality of the macroscopic examination is the only guarantee of its reliability.•This review could serve as a working basis for clinical practice recommendations. The histological examination (HE) of all cholecystectomy specimens removed for cholelithiasis is a widespread practice to rule out unrecognized gallbladder cancer. (GBC). But this dogmatic practice has been called into question by recent published data. The aim of this literature review was to answer two questions: (1) can HE be omitted in specific cases; (2) under what conditions is a selective strategy indicated? A review of the literature was carried out that included selected multicenter studies, registry studies, or meta-analyses. A reliable technique for the surgeon's macroscopic examination of the specimen would allow the selection of dubious cases for HE. The cost-effectiveness of selective HE was discussed. The PICO methodology (population, intervention, comparator, outcome) was used in the selection of articles that compared routine and selective histological examination. If cases from countries with a high prevalence of gallbladder cancer are excluded and in the absence of high-risk situations (advanced age, female gender, calcified or porcelain gallbladder, acute cholecystitis, polyps, abnormalities noted intra-operatively), the macroscopic examination of the gallbladder in the operating room has a reliability approaching 100% in the majority of published studies. This would make it possible to omit systematic HE without compromising the diagnosis and prognosis of patients with unsuspected GBC and with a very favorable cost-effectiveness ratio. Through a selection of patients at very low risk of incidentally-discovered cancer and a routine macroscopic examination of the opened gallbladder, the strategy of selective HE could prove useful in both clinical and economic terms.