Predictive factors for incidental gallbladder dysplasia and carcinoma

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• 作者：Leonardo Solaini ; MD^a ; Amit Sharma ; MBBS^a ; ^b ; Jennifer Watt ; MRCS^a ; Sofia Iosifidou ; MD^a ; Jo-Anne Chin Aleong ; FRCPath^a ; Hemant M. Kocher ; FRCS^a ; ^{h.kocher@qmul.ac.uk" class="auth_mail}
• 关键词：Neoplasia ; Open cholecystectomy ; Laparoscopic cholecystectomy ; Gallstone disease ; Race
• 刊名：Journal of Surgical Research
• 出版年：1 June, 2014
• 年：2014
• 卷：189
• 期：1
• 页码：17-21
• 全文大小：300 K

文摘

Background

This study aims to analyze clinical characteristics and demographics of all patients admitted for cholecystectomy in a tertiary referral center to determine predictors of incidental gallbladder dysplasia (IGBD) and incidental gallbladder carcinoma (IGBC).

Methods

A retrospective analyses of clinical, demographic, and histologic features of patients undergoing cholecystectomy in a single tertiary institution from 2005-2012 were performed using a logistic regression model to determine the predictors of IGBD and IGBC.

Results

Some 771 (28 conversions to open surgery [3.6%]) and 93 patients (10.7%) underwent laparoscopic and open cholecystectomies for gallstone disease, respectively. At final pathology, IGBD (low-grade [n聽=聽10], high-grade [n聽=聽2], mixed-grade [n聽=聽1], and adenoma-associated [n聽=聽5] dysplasia) was found in 18 patients (2%; median age, 45聽y; interquartile range, 42.5-63.5; male-to-female ratio, 1:2; six Caucasian; and 12 Asian). IGBC was found in seven patients (0.8%; median age, 69聽y; interquartile range, 69-72; one Afro-Caribbean; four Caucasian; and two Asian). Logistic regression analysis revealed Asian patients to be at a higher risk of IGBD (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.1-8.0; P聽=聽0.02). Only age (OR, 1.12; 95% CI, 1.04-1.2; P聽<聽0.01) and polypoid lesions (OR, 37.4; 95% CI, 2.97-470.6; P聽=聽0.01) were significantly associated with IGBC. Receiver operating characteristic curve analysis demonstrated that age >68聽y correlated positively to IGBC.

Conclusions

IGBD and IGBC are fairly common incidental histologic finding after cholecystectomy for gallstone disease. When considering cholecystectomy, patients' demographics, in particular age and race, should always be considered as this might help the surgeon and the pathologist to institute the appropriate treatment.