Radiological diagnosis alone risks overtreatment of benign disease in suspected gallbladder cancer: A word of caution in an era of radical surgery

• Published in: Indian journal of cancer 2017-10, Vol.54 (4), p.681-684
• Main Authors: Patkar, Shraddha, Shinde, Rajesh, Kurunkar, Sagar, Niyogi, Devayani, Shetty, Nitin, Ramadwar, Mukta, Goel, Mahesh
• Format: Article
• Language: English
• Subjects: Abdomen; Biomarkers; Cancer; Care and treatment; Cholecystectomy; Diabetes; Diagnosis; Endoscopy; Gallbladder; Gallbladder cancer; Histology; Histopathology; Medical imaging; Patients; Surgery
• ISSN: 0019-509X; 1998-4774
• DOI: 10.4103/ijc.IJC_516_17

BACKGROUND: Incidental gallbladder cancer (iGBC) is on the rise world over. This may be a good scenario as we get to treat GBC in early stages. However, there is a practice of diagnosing patients based on clinicoradiological findings alone and subjecting them to a radical surgical procedure. This approach over-treats patient and has important implications for resource utilization. METHODS: We performed a retrospective analysis of 284 consecutive patients undergoing upfront surgery for suspected GBC from January 2010 to December 2016. The study cohort was divided into two groups, group A - benign (n = 138, 48.6%) and group B - malignant (n = 146, 51.4%). Both groups were compared with respect to demographic characteristics, tumor marker levels, clinicoradiological features, and perioperative outcomes. RESULTS: Approximately 48.6% patients with clinicoradiological suspicion of GBC turned out to be benign on final histology as confirmed on frozen section evaluation (FS). Only 2 patients who were reported benign on FS required revision surgery for malignancy in the final histopathology report. Demographic and clinicoradiological characteristics in both groups were comparable. However, there was a significant difference in blood loss, postoperative hospital stay, and complications between the two groups (P < 0.005). CONCLUSION: Every other patient who presented to a tertiary cancer center with high index suspicion for malignancy, based on clinicoradiological findings, turned out to be benign on final histology. This emphasizes the fact that, as a norm, for radiologically suspected gallbladder malignancy, we need to have a confirmed histological diagnosis at least during surgery before proceeding to radical resection.