Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands.
Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands.
Eur J Surg Oncol. 2020 Apr;46(4 Pt A):572-576. doi: 10.1016/j.ejso.2019.11.497. Epub 2019 Nov 14.
It was hitherto common practice to analyse each removed gallbladder for the presence of gall bladder cancer (GBC) although this approach may be questioned. The aim of this study was to determine whether a policy of selective histopathological analysis (Sel-HPA) is oncologically safe and cost effective.
This retrospective study was conducted in a single Dutch teaching hospital. Immediately following cholecystectomy, the surgeon decided on the basis of inspection and palpation whether histological examination was indicated. The Dutch Comprehensive Cancer Organisation (IKNL) registry was used to identify the number of GBC during this time period.
Of 2271 patients who underwent a cholecystectomy in our institution between January 2012 and December 2017, 1083 (47.7%) were deemed indicated for histopathological analysis. Sixteen pathological gallbladders (1.5%) were identified in that period (intestinal metaplasia, n = 3; low grade dysplasia n = 7; carcinoma n = 6). During follow-up, no patient was found to have GBC recurrence in the population whose gallbladder was not sent for pathology (52.3%, n = 1188, median 49 months of follow up). The percentage of gallbladders that were analysed decreased over the six years of observation from 83% to 38%. Our policy of Sel-HP saved over €65 000.
A policy of selective histopathology after cholecystectomy is oncologically safe and reduces costs.
虽然这种方法可能存在争议，但此前人们通常会对切除的胆囊进行分析以确定是否存在胆囊癌（GBC）。本研究旨在确定选择性组织病理分析（Sel-HPA）的策略是否在肿瘤学上安全且具有成本效益。
本研究为单中心回顾性研究。在胆囊切除术后，外科医生根据检查和触诊结果决定是否需要进行组织学检查。本研究使用荷兰综合癌症组织（IKNL）登记处确定了该时间段内 GBC 的数量。
2012 年 1 月至 2017 年 12 月期间，我院共对 2271 例患者进行了胆囊切除术，其中 1083 例（47.7%）被认为需要进行组织病理分析。在此期间，发现 16 例病理性胆囊（肠上皮化生 3 例，低级别异型增生 7 例，癌 6 例）。在随访期间，未在未进行病理检查的患者（52.3%，n=1188，中位随访时间 49 个月）中发现 GBC 复发。在六年的观察期间，分析的胆囊百分比从 83%下降到 38%。Sel-HPA 策略为我们节省了超过 65000 欧元。
胆囊切除术后进行选择性组织病理学检查具有肿瘤学安全性，并可降低成本。
