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KMID : 0614620100550010052
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Korean Journal of Gastroenterology
2010 Volume.55 No. 1 p.52 ~ p.57
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Critical Reappraisal of Cholecystectomy in Patients with Asymptomatic Gallstones for Early Diagnosis and Removal of Dysplasia and Cancer
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Jung Sung-Joo
Kim Jae-Seon
Hong Seung-Goun
Joo Moon-Kyung
Lee Beom-Jae
Kim Ji-Hoon
Yeon Jong-Eun
Park Jong-Jae
Byun Kwan-Soo
Park Young-Tae
Kim Wan-Bae
Choi Sang-Yong
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Abstract
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Background/Aims : 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 (>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.
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KEYWORD
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Asymptomatic gallstone, Gallbladder cancer
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