[Critical reappraisal of cholecystectomy in patients with asymptomatic gallstones for early diagnosis and removal of dysplasia and cancer].
OBJECTIVE
It has been known that chronic trauma and inflammation of gallbladder (GB) mucosa by gallstones (GS) can induce epithelial dysplasia, carcinoma in situ, and invasive cancer. This study was designed to investigate the usefulness of cholecystectomy in patients with asymptomatic GS for the early diagnosis and removal of dysplasia or cancer.


METHODS
From January 2004 to July 2008, the clinical records of 703 cases with GS who underwent cholecystectomy at Korea University Guro Hospital were reviewed, and the prevalence of dysplasia and cancer was analyzed.


RESULTS
In symptomatic GS (542 cases) group, low grade dysplasia was found in 4 cases (0.74%) and high grade dysplasia in 1 case (0.18%). In asymptomatic GS (161 cases) group, low grade dysplasia was found in 4 cases (2.48%) and cancer in 2 cases (1.24%) (p=0.012 vs. symptomatic cases). Dysplasias in symptomatic GS group were not associated with polyps, but dysplasias and cancers in asymptomatic GS group were associated. Patients with asymptomatic GS and polyps were analyzed according to the size of polyps. In those (12 cases) with larger polyps (> or 1 cm), low grade dysplasia was found in 2 cases and cancer in 2 cases. And in those (12 cases) with smaller polyps (<1 cm), low grade dysplasia was found in 2 cases.


CONCLUSIONS
Extending indication of prophylactic cholecystectomy in patients with asymptomatic GS without polyp to prevent GB dysplasia or cancer beyond the existing indication does not seem to be justifiable in Korea. However, further studies are needed in patients with asymptomatic GS and polyp of any size.
Jung
Sung Joo
SJ
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Kim
Jae Seon
JS
Hong
Seung Goun
SG
Joo
Moon Kyung
MK
Lee
Beom Jae
BJ
Kim
Ji Hoon
JH
Yeon
Jong Eun
JE
Park
Jong Jae
JJ
Byun
Kwan Soo
KS
Bak
Young Tae
YT
Kim
Wan Bae
WB
Choi
Sang Yong
SY
D000328:Adult; D002763:Cholecystectomy; D003937:Diagnosis, Differential; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000209:etiology; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D011230:Precancerous Conditions / Q000175:diagnosis*; D012189:Retrospective Studies