Safety and economic analysis of selective histopathology following cholecystectomy: multicentre, prospective, cross-sectional FANCY study.

Autor:	Bastiaenen VP; Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands., van Vliet JLP; Department of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands., de Savornin Lohman EAJ; Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands., Corten BJGA; Department of Surgery, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands., de Jonge J; Department of Surgery, Tergooi Hospital, 1213 XZ Hilversum, The Netherlands., Kraima AC; Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.; Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands., Swank HA; Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.; Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands., van Acker GJD; Department of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands., van Geloven AAW; Department of Surgery, Tergooi Hospital, 1213 XZ Hilversum, The Netherlands., In 't Hof KH; Department of Surgery, Flevo Hospital, 1315 RA Almere, The Netherlands., Koens L; Department of Pathology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands., de Reuver PR; Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands., van Rossem CC; Department of Surgery, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands., Slooter GD; Department of Surgery, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands., Tanis PJ; Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands., Terpstra V; Department of Pathology, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands., Dijkgraaf MGW; Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands., Bemelman WA; Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	The British journal of surgery [Br J Surg] 2022 Mar 15; Vol. 109 (4), pp. 355-362.
DOI:	10.1093/bjs/znab469
Abstrakt:	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. (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.)
Databáze:	MEDLINE
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