Department of Surgery, Linköping University, Linköping, Sweden.
Department of Radiology in Linköping, Linköping University, Linköping, Sweden.
Scand J Gastroenterol. 2021 Apr;56(4):458-462. doi: 10.1080/00365521.2021.1884895. Epub 2021 Feb 16.
Gallbladder cancer is a rare but aggressive malignancy. Surgical resection is recommended for gallbladder polyps ≥10 mm. For gallbladder wall thickening, resection is recommended if malignancy cannot be excluded. The incidence of gallbladder malignancy after cholecystectomy with indications of polyps or wall thickening in the Swedish population is not known.
MATERIAL/METHODS: A retrospective study was performed at Linköping University Hospital and included patients who underwent cholecystectomy 2010 - 2018. All cholecystectomies performed due to gallbladder polyps or gallbladder wall thickening without other preoperative malignant signs were identified. Preoperative radiological examinations were re-analysed by a single radiologist. Medical records and histopathology reports were analysed.
In all, 102 patients were included, of whom 65 were diagnosed with gallbladder polyps and 37 with gallbladder wall thickening. In each group, one patient (1.5% and 2.7% in each group) had gallbladder malignancy ≥ pT1b.Two (3.1%) and three (8.1%) patients with gallbladder malignancy < T1b were identified in each group.
DISCUSSION/CONCLUSION: This study indicates that the incidence of malignancy is low without other malignant signs beyond gallbladder polyps and/or gallbladder wall thickening. We propose that these patients should be discussed at a multidisciplinary tumour board. If the polyp is 10-15 mm or if the gallbladder wall is thickened but no other malignant signs are observed, cholecystectomy can be safely performed by an experienced general surgeon at a general surgery unit. If the histopathology indicates ≥ pT1b, the patient should be referred immediately to a hepatobiliary centre for liver and lymph node resection.
胆囊癌是一种罕见但侵袭性很强的恶性肿瘤。对于≥10mm 的胆囊息肉，建议进行手术切除。对于胆囊壁增厚，如果不能排除恶性肿瘤，则建议进行切除。在瑞典人群中，有胆囊息肉或胆囊壁增厚指征的胆囊切除术患者的胆囊恶性肿瘤发病率尚不清楚。
材料/方法：在林雪平大学医院进行了一项回顾性研究，纳入了 2010 年至 2018 年期间接受胆囊切除术的患者。所有因胆囊息肉或胆囊壁增厚而无其他术前恶性征象而行胆囊切除术的患者均被识别。由一名放射科医生对术前影像学检查进行重新分析。对病历和组织病理学报告进行分析。
共纳入 102 例患者，其中 65 例诊断为胆囊息肉，37 例诊断为胆囊壁增厚。每组均有 1 例（每组 1.5%和 2.7%）患者患有≥pT1b 的胆囊恶性肿瘤。每组还分别发现了 2 例（3.1%）和 3 例（8.1%）<T1b 的胆囊恶性肿瘤患者。
讨论/结论：本研究表明，在无其他恶性征象的情况下，胆囊息肉和/或胆囊壁增厚患者的恶性肿瘤发病率较低。我们建议对这些患者进行多学科肿瘤委员会讨论。如果息肉为 10-15mm 或胆囊壁增厚但无其他恶性征象，则经验丰富的普外科医生可在普外科安全地进行胆囊切除术。如果组织病理学检查表明≥pT1b，则应立即将患者转介至肝胆中心进行肝和淋巴结切除术。
