title: Selective laparoscopic approach in suspected gallbladder malignancy.
abstract: OBJECTIVE
  We examined patients with clinical findings that are concerning for gallbladder malignancy to determine the incidence of pathology-confirmed malignancy and to discover factors that may be used to determine which patients may be initially treated with a laparoscopic approach.
  
  
  METHODS
  All patients referred to a surgical oncologist with preoperative findings that are concerning for gallbladder malignancy who had not undergone previous surgical resection from 2005 to 2011 were reviewed. Variables collected included demographics, imaging, operative findings, and final pathology. Patients were grouped into 3 categories based on preoperative findings: gallbladder mass, irregular wall thickening, and abnormal intraoperative findings on previous diagnostic laparoscopy.
  
  
  RESULTS
  Twenty-nine of 4474 patients evaluated for gallbladder pathology during the study period met the inclusion criteria. Preoperative imaging included computed tomography, ultrasonography, and magnetic resonance imaging. Twelve patients had multiple imaging studies. Eight patients were initially treated with a laparoscopic approach with 3 conversions to an open procedure. Forty-eight percent of patients had pathology-confirmed malignancy. Patients without a discrete mass on imaging were more likely to have benign disease (P = .04).
  
  
  CONCLUSIONS
  Our results demonstrate that >50% of patients with suspicious preoperative findings had benign pathology, suggesting that the initial laparoscopic approach in selected patients may be appropriate.
authors.affiliation: Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, 1000 Monroe NW, Grand Rapids, MI 49503, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA. paul.wright@grmep.com.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.affiliation: Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
authors.forename: Arida
authors.initials: A
authors.lastname: Siripong
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Winton
authors.affiliation: Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA, Spectrum Health Medical Group, Grand Rapids, MI, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Mitchell
authors.affiliation: Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Goslin
authors.affiliation: Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA, Spectrum Health Medical Group, Grand Rapids, MI, USA.
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult