Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center

Yıl 2017, Cilt: 9 Sayı: 3, 243 - 249, 22.09.2017

Erdal Uysal Efe Sezgin Hasan Bakir Ahmet Gurer Mehmet Sokucu

https://doi.org/10.18521/ktd.325651

Cited By: 1

Öz

Objective: it was aimed to evaluate the results of routine histopathological
examination after cholecystectomy and to investigate the necessity of routine
histopathologic examination after cholecystectomy.

 Methods: The study was designed retrospectively. 1366 patients who
underwent laparoscopic and open cholecystectomy at our center with
pre-diagnosis of benign gallbladder disease between November 2011 and May
2017were included in the study. Patients' demographic data, pathologic results, macroscopic
appearance of the specimen, and cancer staging were recorded. The distribution
and frequency of pathologic diagnoses and the prevalence of incidental gallbladder cancer (GBC) were
evaluated. Pathologic findings were compared in terms of age groups and gender
relations.

Results: The
number of patients included in the study was 1,366. 1,303 patients (95%) were
diagnosed with chronic cholecystitis, 39 (3%) with acute cholecystitis, 7
(0.5%) with  GBC, and 17 (1.5%) with other diagnoses of the
patients. Statistical
significance was found between the groups in terms of the mean age (p =
0.0002). Comparisons
between groups in terms of cholesterolysis were statistically significant (p =
0.0003). There was a
significant relationship between mucosa atrophy and gender (p = 0.001).

Discussion: The
histopathological spectrum of gallbladder is quite extensive. Incidental GBC
may not be detected by preoperative imaging methods. Incidental GBC are usually
asymptomatic. T2, T3 and T4 GBC were also encountered in our study. All of
these patients need additional operations. In the absence of routine
histopathologic examination, metastatic advanced GBC may be encountered because
no treatment plans could make. Thus, we do recommend routine histopathological
examination.

Anahtar Kelimeler

gallbladder, cancer, cholesterolysis, dysplasia, metaplasia, histopathologia

Kolesistektomi sonrası rutin histopatlojik safra kesesi incelemesi gerekli mi?: Tek merkezdeki 1366 kolesistektomi spesmeninin sonuçlarının değerlendirilmesi

Öz

Amaç: Kolesistektomi
sonrası rutin olarak yapılan histopatolojik inceleme sonuçlarının
değerlendirilmesi, kolesistektomiler sonrası rutin histopatolojik incelemenin
gerekliliğini araştırmak amaçlanmıştır.

Gereç ve Yöntem: Çalışma
retrospektif olarak dizayn edilmiştir. Bening safra kesesi hastalığı ön tanısı
ile Kasım 2011- Mayıs 2017 yılları arasında merkezimizde Laparaskopik ve açık
kolesistektomi uygulanan 1366 hasta çalışmaya dahil edildi. Hastaların
demografik verileri, patoloji sonuçları, spesmenin makroskopik görünümü, kanser
evrelemesi kayıt edildi. Patolojik tanıların dağılımı ve sıklığı,
incidental safra kesesi kanseri prevalansı değerlendirildi.

Bulgular: Çalışmaya
dahil edilen hasta sayısı 1366 idi. Hastaların 1303 (%95)’ü kronik kolesistit,
39 (%3)’u akut kolesistit, 7 (%0.5)’i safra kesesi kanseri, 17 (%1.5) hastada
diğer tanılar tespit edildi. Gruplar arasında yaş ortalaması
açısından istatistiksel anlamlılık saptandı (p=0.0002). Kolesterolizis
açısından gruplar arasında yapılan karşılaştırmalarda istatistiksel olarak
anlamlılık bulundu (p=0.0003). Mukoza atrofisi ile cinsiyet
arasında anlamlı ilişki tespit edildi (p=0.001).

Tartışma: Safra
kesesi spesmenlerinin histopatolojik incelenmesinde en sık görülen tanı kronik
kolesistitdir. Ancak kolesistektomi sonrası, safra kesesinin histopatolojik
spekturumu oldukça geniştir. İncidental safra kesesi tümörleri preoperative
görüntüleme yöntemleri ile tespit edilemeyebilir. İncidental safra kesesi
tümörleri genellikle asemptomtomatik seyretmektedir. Çalışmamızda T2, T3 ve T4
safra kesesi tümörlerine de rastlanılmıştır. Bu hastaların tümüne ek girişimler
gerekmiştir. Rutin histopatolojik inceleme yokluğunda, tedavi planı
yapılamadığından metastatic ileri evre safra kesesi tümörleriyle
karşılaşılabilir. Bu nedenle rutin histopatolojik incelemenin yapılmasını
önermekteyiz.

Anahtar Kelimeler

safra kesesi, histopatoloji, kanser, kolesterolizis, displazi, metaplazi

Kaynakça

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