title: Reassessing the need for prophylactic surgery in patients with porcelain gallbladder: case series and systematic review of the literature.
abstract: OBJECTIVE
  To evaluate the risk of gallbladder cancer (GBC) in patients with a porcelain gallbladder (PGB).
  
  
  METHODS
  Retrospective analysis of our institutional experience and a systematic review of the literature.
  
  
  METHODS
  Academic teaching facility, Parkland Memorial Hospital, and the Dallas Veterans Affairs Medical Center (all in Dallas, Texas).
  
  
  METHODS
  Medical records of 1200 cholecystectomies performed between 2008 and 2009 at Parkland Memorial Hospital, The University of Texas Southwestern Medical Center, and the Dallas Veterans Affairs Medical Center were reviewed. Patients with radiologic or histologic evidence of PGB or GBC were included.
  
  
  METHODS
  The risk of GBC in patients with a PGB was assessed by contingency table analysis.
  
  
  RESULTS
  We identified 13 patients with a PGB among 1200 cholecystectomies (1.1%). Most of these patients had concomitant gallstones (n = 9). None of the patients with a PGB had evidence of carcinoma. We also reviewed the histologic analysis results of 35 cases of GBC operated on between 1997 and 2009; none of these had gallbladder wall calcifications. Most patients underwent a laparoscopic cholecystectomy without any postoperative complications. We reviewed 7 published series that included 60,665 cholecystectomies. The overall incidence of PGB was 0.2%, and GBC occurred in 15% of the PGB cases. Most cases of GBC occurring in PGB were found in the older literature; in the contemporary series, there were few reports of GBC associated with a PGB.
  
  
  CONCLUSIONS
  Porcelain gallbladder is only weakly associated with GBC. Prophylactic cholecystectomy is not indicated for PGB alone and should be performed only in patients with conventional indications for cholecystectomy. A laparoscopic approach is appropriate for most patients with a PGB.
authors: Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Zarrish S
authors: ZS
authors: Khan
authors: Edward H
authors: EH
authors: Livingston
authors: Sergio
authors: S
authors: Huerta
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012189:Retrospective Studies; D012307:Risk Factors