TY - JOUR
T1 - Safety and economic analysis of selective histopathology following cholecystectomy
T2 - multicentre, prospective, cross-sectional FANCY study
AU - Bastiaenen, Vivian P.
AU - van Vliet, Jaap L. P.
AU - de Savornin Lohman, Elise A. J.
AU - Corten, Bartholomeus J. G. A.
AU - de Jonge, Joske
AU - Kraima, Anne C.
AU - Swank, Hilko A.
AU - van Acker, Gijs J. D.
AU - van Geloven, Anna A. W.
AU - in 't Hof, Klaas H.
AU - Koens, Lianne
AU - de Reuver, Philip R.
AU - van Rossem, Charles C.
AU - Slooter, Gerrit D.
AU - Tanis, Pieter J.
AU - Terpstra, Valeska
AU - Dutch Snapshot Research Group
AU - Dijkgraaf, Marcel G. W.
AU - Bemelman, Willem A.
N1 - Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - BACKGROUND: There is ongoing debate concerning the necessity of routine histopathological examination following cholecystectomy. In order to reduce the pathology workload and save costs, a selective approach has been suggested, but evidence regarding its oncological safety is lacking. METHODS: In this multicentre, prospective, cross-sectional study, all gallbladders removed for gallstone disease or cholecystitis were systematically examined by the surgeon for macroscopic abnormalities indicative of malignancy. Before sending all specimens to the pathologist, the surgeon judged whether histopathological examination was indicated. The main outcomes were the number of patients with hypothetically missed malignancy with clinical consequences (upper limit two-sided 95 per cent c.i. below 3:1000 considered oncologically safe) and potential cost savings of selective histopathological examination. RESULTS: Twenty-two (2.19:1000) of 10 041 specimens exhibited malignancy with clinical consequences. In case of a selective policy, surgeons would have held back 7846 of 10041 (78.1 per cent) gallbladders from histopathological examination. Malignancy with clinical consequences would have been missed in seven of 7846 patients (0.89:1000, upper limit 95% c.i. 1.40:1000). No patient benefitted from the clinical consequences, while two were harmed (futile additional surgery). Of 15 patients in whom malignancy with clinical consequences would have been diagnosed, one benefitted (residual disease radically removed), two potentially benefitted (palliative systemic therapy), and four experienced harm (futile additional surgery). Estimated cost savings established by replacing routine for selective histopathological examination were €703 500 per 10 000 patients. CONCLUSION: Selective histopathological examination following cholecystectomy is oncologically safe and could reduce pathology workload, costs, and futile re-resections.
AB - BACKGROUND: There is ongoing debate concerning the necessity of routine histopathological examination following cholecystectomy. In order to reduce the pathology workload and save costs, a selective approach has been suggested, but evidence regarding its oncological safety is lacking. METHODS: In this multicentre, prospective, cross-sectional study, all gallbladders removed for gallstone disease or cholecystitis were systematically examined by the surgeon for macroscopic abnormalities indicative of malignancy. Before sending all specimens to the pathologist, the surgeon judged whether histopathological examination was indicated. The main outcomes were the number of patients with hypothetically missed malignancy with clinical consequences (upper limit two-sided 95 per cent c.i. below 3:1000 considered oncologically safe) and potential cost savings of selective histopathological examination. RESULTS: Twenty-two (2.19:1000) of 10 041 specimens exhibited malignancy with clinical consequences. In case of a selective policy, surgeons would have held back 7846 of 10041 (78.1 per cent) gallbladders from histopathological examination. Malignancy with clinical consequences would have been missed in seven of 7846 patients (0.89:1000, upper limit 95% c.i. 1.40:1000). No patient benefitted from the clinical consequences, while two were harmed (futile additional surgery). Of 15 patients in whom malignancy with clinical consequences would have been diagnosed, one benefitted (residual disease radically removed), two potentially benefitted (palliative systemic therapy), and four experienced harm (futile additional surgery). Estimated cost savings established by replacing routine for selective histopathological examination were €703 500 per 10 000 patients. CONCLUSION: Selective histopathological examination following cholecystectomy is oncologically safe and could reduce pathology workload, costs, and futile re-resections.
UR - http://www.scopus.com/inward/record.url?scp=85126830297&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/bjs/znab469
DO - https://doi.org/10.1093/bjs/znab469
M3 - Article
C2 - 35245363
SN - 0007-1323
VL - 109
SP - 355
EP - 362
JO - The British journal of surgery
JF - The British journal of surgery
IS - 4
ER -