Porcelain Gallbladder: No Longer an Indication for Prophylactic Cholecystectomy

摘要

Porcelain gallbladder (PG) was historically associated with gallbladder cancer (GBC), (range 12-62%, largest series n 5 26). Presently, cholecystectomy is still performed in many patients with PG. The objective of this study was to determine the incidence of GBC in patients with radio-graphic diagnosis of PG. We conducted a retrospective chart review of the Kaiser Permanente southern California electronic medical record database and identified patients with radiographic diagnosis of PG between 2008 and 2013. Extracted were patient demographics, imaging modality, symptoms, surgical and observational outcomes, and pathology results. Out of 192 PG patients, 102 underwent cholecystectomy, and 90 were observed. None of the patients in the surgery group had GBC on pathology review, and none of the observed patients developed GBC during follow-up (mean 3.5 years). In the surgery group, 82 per cent of the patients were asymptomatic with a perioperative complication rate of 10.7 per cent. Among symptomatic patients, the complication rate was 16.7 per cent. Rate of conversion to open surgery was 5 per cent. Complications led to eight endoscopic or percutaneous interventions and five additional operations. PG is not associated with increased risk of GBC but is associated with high risk of postoperative complications. Cholecystectomy should not be recommended in asymptomatic patients with PG. Porcelain gallbladder (PG) is a well-known radiographic and pathologic entity characterized by calcifications of the gallbladder wall. Between the 1950s and 1980s, several studies (largest series n 4 26) demonstrated a strong association between PG and gallbladder cancer (GBC), estimating the risk from 12 per cent to 60 per cent. As a result, PG attained a reputation for being a precursor of GBC or an indicator of existing GBC. This gave rise to a surgical dogma that cholecystectomy should be performed in all patients with calcified gallbladders. More recently several studies (largest series n 4 44) have shown a much weaker association between PG and GBC, estimating the risk from 0 per cent to 5 per cent. These studies supported the safety and feasibility of laparoscopic cholecystectomy (LC) for PG. Despite these recent findings, PG is still regarded as an indication for prophylactic cholecystectomy for most medically fit patients. Although cholecystectomy continues to be pursued in patients with PG, little is known about their surgical outcomes.