Kolesistektomi Sonrası Histopatolojik İnceleme Gereklilik mi Yoksa Fazlalık mı?

Öz

kesesi kanseri insidansı çok düşüktür. Bu çalışmanın amacı kolesistektomi sonrası çıkarılan tüm spesmenler yerine preoperatif ve peroperatif şüphe halinde seçici bir histopatolojik inceleme yapılıp yapılmayacağının sonucunu araştırmaktır. Materyal ve metod: Bu çalışma, Amasya Sabuncuoğlu Şerefeddin Eğitim ve Araştırma Hastanesi’nde 1 Ocak 2015-31 Aralık 2024 tarihleri arasında kolesistektomi yapılan ve histopatolojik olarak incelenen 2.355 hasta ile retrospektif olarak gerçekleştirildi. Patoloji sonuçları benign, premalign ve malign olarak 3 grubaayrıldı. Bulgular: Çalışmaya dahil edilen 2.355 hastanın 569’u (%24,2) erkek, 1.786’sı (%75,8) kadındı. Yaş ortalaması 56,45 minimum: 18 maximum: 98 olarak bulundu. Patoloji incelemesinin %99,2 sinde benign lezyonlar tespit edildi. Geriye kalan patolojik spesmenlerin 6 tanesi (%0,3) low grade displazi, 7 tanesi (%0,3) biliyer intraepitelyal neoplazi (low grade) olmak üzere %0,6’sında premalign lezyonlar bulundu. Hastaların sadece 5 tanesinde (%0,2) sinde safra kesesi kanseri tespit edildi. Sonuç: Bu çalışmaya dahil edilen 2.355 hastanın patolojisinde %0,6’sında premalign lezyonlar, %0,2’sinde malignite tespit edilmiştir. Malignite tespit edilen tüm spesimenlerde ya preoperatif görüntülemelerde ya da intraoperatif bulgularda maligniteyi öngörebilecek durumlar mevcuttu. Bu bağlamda preoperatif görüntülemelerde ve intraoperatif olarak şüpheli bir durum olmaması halinde ya da özellikli risk faktörü taşımayan gruplarda rutin histopatolojik inceleme gerekmeyebileceğini düşünmekteyiz. Bu durum çok sık gerçekleştirilen bir ameliyat olması sebebiyle iş gücü kaybının azalacağını ve maliyetlerin düşebileceğini göstermektedir.

Anahtar Kelimeler

• Displazi
• Histopatolojik inceleme
• Kanser
• Kolesistektomi
• Safra kesesi

Is Histopathological Examination After Cholecystectomy Necessary or Redundant?

Öz

Background: Although cholecystectomy is one of the most frequently performed surgeries in general surgical practice, the incidence of gallbladder cancer is very low. The aim of this study is to investigate whether selective histopathological examination, based on preoperative and perioperative suspicion, can replace routine examination of all specimens removed after cholecystectomy. Materials and Methods: This study was conducted retrospectively with 2,355 patients who underwent cholecystectomy and were examined histopathologically between January 1, 2015 and December 31, 2024 at Amasya Sabuncuoğlu Şerefeddin Training and Research Hospital. Pathology results were divided into 3 groups as benign, premalignant and malignant. Results: Of the 2,355 patients included in the study, 569 (24.2%) were male and 1,786 (75.8%) were female. The average age was found to be 56.45 (minimum: 18 maximum: 98). Benign lesions were detected in 99.2% of specimens. Premalignant lesions were found in 0.6% of the remaining specimens, including 6 (0.3%) cases of low-grade dysplasia and 7 (0.3%) cases of biliary intraepithelial neoplasia (low grade). Only five (0.2%) of the patients had gallbladder cancer. Conclusions: In the pathology of 2,355 patients included in this study, premalignant lesions were detected in 0.6% and malignancy in 0.2%. In all specimens that were malignant, either preoperative imaging or operative findings predicted malignancy. In this context, we believe routine histopathological examination is unnecessary when preoperative and intraoperative imaging does not reveal any suspicious findings and when there are no special risk factors. This suggests that, as it is a common surgery, there will be a reduction in labor loss and a potential decrease in costs.

Anahtar Kelimeler

• Cancer
• Cholecystectomy
• Dsplasia
• Gallbladder
• Histopathological examination

Kaynakça

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