Nytteverdi av rutinemessig histologisk undersøkelse av ekstiperte galleblærer

Abstract

Abstract Introduction: Today all gall bladders that are removed are being routinely sent for histological examination regardless of suspicion for maligniancies or not. Gall bladder carcinoma (GBC) is a rare, but serious cancer type, mainly because of it’s lack of symptoms early in it’s progression. Most cancers of the gall bladder are often well progressed by the time of diagnosis. However, the amount of gall bladders that are being removed due to non-malignant conditions such as cholecystolithiasis far outweigh the number of carcinomas. The purpose of this study is if there’s any justification for routinely examining all gall bladders even though there’s no suspicion of malignancies and if it affect survival. Patients and methods: 3241 gall bladders were examined at Ullevål US and Ahus in the period from 2000 to 2007. 15 malignancies of the gall bladder were found. 2 of the patients with gall bladder carcinoma refused to participate in the study. Results: 5 GBC staged Tis were found, none T1, one T2, four T3, three T4. All the patients with Tis, the patient with T2 and one of the patients with T3 were alive 5 years after diagnosis was made. The remaining three with T3 and the three with T4 staged cancer all died within 5 years. The first suspicion of malignancy was made preoperatively in all but one of the patients with GBC staged T2-T4. One of the T4 cancers was first found during operation. The five GBC staged Tis was first found histologically. Conclusion/discussion: In this material, none of the patients benefitted from the routine examination of extirpated gall bladders. One of the problems is that this is a rare type of cancer and getting good estimates is hard. Other studies have found different distribution of the stages of cancer, but none have a big enough material to give clear cut conclusions. A study that had 117000 laparoscopic gall bladder operations and they were all examined afterwards, gave us a good estimate of how often this cancer is found first at histological examination. According to our numbers, the routine histological examination did not affect outcome in any patients. Following other studies, they don’t seem to have any significant effect. If we use the numbers from the huge european study, we would need to have to examine 1350 gall bladders in order to find one metastasizing tumour. The costs per finding varies between 200 000 NOK and 250 000 NOK, but the impact on survival is hard to assess due to the only study we found on this was fra 1981-1986. Overall, with modern diagnostics and awareness of this type of cancer, it would be safe to only send the gall bladders from patients fulfilling high risk criterias or when the surgeon suspects malignancy. The important part here is to be selective, but also have a low threshold seeing as histo-pathological examination is a fairly inexpensive procedure.