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Background <p>The traditional practice is to send all gallbladder specimens for routine histopathological evaluation after cholecystectomy. We aimed to investigate the incidence of gallbladder dysplasia/neoplasia, the rate of subtotal cholecystectomy, and to identify criteria for selective histopathological examination of resected gallbladders.</p> Methods <p>We performed a prospective multi-centre observational study of patients undergoing laparoscopic cholecystectomy between January 2020 and June 2021, with subsequent four-year follow-up. Multivariate logistic regression models were used to identify patient factors associated with incidental gallbladder carcinoma (IGBC) and to compare outcomes between total and subtotal cholecystectomy.</p> Results <p>A total of 959 patients (631 elective and 328 emergency cholecystectomies) with a median age of 48 years (IQR 35–59) were included. Subtotal cholecystectomy was performed in 27 patients (2.8%) and was associated with higher rates of postoperative complications (OR 4.69, <i>P</i> = 0.026). No common bile duct injuries or remnant gallbladder cancers were identified among patients with imaging at four-year follow-up. Eight patients (0.8%) had IGBC; five of these had no suspicious intraoperative macroscopic features, and one required further oncologic surgery. Gallbladder polyps were independently associated with increased likelihood of dysplasia/IGBC (OR 14.49, <i>P</i> = 0.014), while patients with dysplasia/IGBC had longer waiting times to surgery descriptively.</p> Conclusion <p>Our findings support the recommendation of the Royal College of Pathologists to routinely examine all resected gallbladder specimens. Preoperative gallbladder polyps represent a clinical “red flag”. Overt macroscopic abnormalities may be absent in IGBC cases, and we identified no reliable patient factors to justify a selective histology policy.</p>

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Unmasking the Unexpected: The Role of Routine Histology in Detecting Incidental Gallbladder Cancer Post-Cholecystectomy

  • 期刊论文

  • 发表日期：

    2026年4月21日

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  • Mohammed Hamid,
  • Marie Kershaw,
  • Muhammad Mushtaq,
  • Shafquat Zaman,
  • Ali Yasen Mohamedahmed,
  • Mohamed Talaat Issa,
  • Resya Bhakthavalsalan,
  • Sian Davies,
  • Rajwinder Nijjar,
  • Ricardo Camprodon,
  • Zuhair Ahmed

摘要

Background

The traditional practice is to send all gallbladder specimens for routine histopathological evaluation after cholecystectomy. We aimed to investigate the incidence of gallbladder dysplasia/neoplasia, the rate of subtotal cholecystectomy, and to identify criteria for selective histopathological examination of resected gallbladders.

Methods

We performed a prospective multi-centre observational study of patients undergoing laparoscopic cholecystectomy between January 2020 and June 2021, with subsequent four-year follow-up. Multivariate logistic regression models were used to identify patient factors associated with incidental gallbladder carcinoma (IGBC) and to compare outcomes between total and subtotal cholecystectomy.

Results

A total of 959 patients (631 elective and 328 emergency cholecystectomies) with a median age of 48 years (IQR 35–59) were included. Subtotal cholecystectomy was performed in 27 patients (2.8%) and was associated with higher rates of postoperative complications (OR 4.69, P = 0.026). No common bile duct injuries or remnant gallbladder cancers were identified among patients with imaging at four-year follow-up. Eight patients (0.8%) had IGBC; five of these had no suspicious intraoperative macroscopic features, and one required further oncologic surgery. Gallbladder polyps were independently associated with increased likelihood of dysplasia/IGBC (OR 14.49, P = 0.014), while patients with dysplasia/IGBC had longer waiting times to surgery descriptively.

Conclusion

Our findings support the recommendation of the Royal College of Pathologists to routinely examine all resected gallbladder specimens. Preoperative gallbladder polyps represent a clinical “red flag”. Overt macroscopic abnormalities may be absent in IGBC cases, and we identified no reliable patient factors to justify a selective histology policy.