Posted: Monday, February 6, 2023
Researchers analyzed the occurrence of gallbladder carcinoma and benign disease in radical cholecystectomy in regions such as North India, with a high incidence of this type of gastrointestinal cancer. Rajesh Gupta, MBBS, MS, MCh, of Postgraduate Institute of Medical Education and Research, Chandigarh, India, and colleagues reported in the journal BMC Surgery that many patients with benign diseases may be undergoing unnecessary operations, greatly increasing the risk of more serious conditions.
“The high prevalence of gallstone disease in the endemic region of carcinoma gallbladder results in a significant proportion of benign conditions undergoing major resection (24.6%),” explained the study authors. “Also, an alarming percentage of patients presented with missed carcinoma gallbladder (25.7%). Considering the high rate of metastatic disease (21%) in incidental carcinoma, all attempts should be made to prevent gallbladder perforation and minimize bile spillage during all laparoscopic cholecystectomies.”
The researchers examined a database of all patients admitted to the tertiary care center of North India with the diagnosis of gallbladder carcinoma between July 2019 and January 2022. All patients underwent a contrast-enhanced CT of the abdomen to assess resectability, and those with clinically resectable disease underwent diagnostic laparoscopy or exploratory laparotomy. Lastly, all patients had both lymph nodal clearance of the hepatoduodenal ligament with complete skeletonization of the common bile duct, hepatic artery, and portal vein, as well as removal of posterosuperior and posteroinferior pancreaticoduodenal lymph nodes.
Of the 148 patients included in the study, 110 had gallbladder carcinoma, 38 had incidental carcinoma (considered “underdiagnosed”), and 15 had benign pathology (considered “overdiagnosed”). Radical resection was performed in 61 of the 110 patients with clinical gallbladder carcinoma. Overdiagnosis of benign pathology was attributed to xanthogranulomatous cholecystitis, chronic cholecystitis, tuberculosis, and IgG4-related cholecystitis. Patient histories of extreme weight loss and anorexia were associated with malignancy, according to the authors, and asymmetrical wall thickness was common in misdiagnosed cases. Overdiagnosis of gallbladder carcinoma occurred in 24.6% of observed patients, and incidental carcinoma was present in 25.7% of all admissions for gallbladder carcinoma.
Disclaimer: The study authors reported no conflicts of interest.