Current Management of Gallbladder Polyp: Should Cholecystectomy Be Recommended for Polyps Smaller than 10 mm?

摘要

Gallbladder polyps are found incidentally in 1 to 5 per cent of adults in Western populations and 9.6 per cent in Asian populations during right upper quadrant ultrasound or after cholecystectomy.1 The lesions can be classified as benign or malignant. Benign lesion consists of nonneoplastic (cholesterolosis, adenomyomas, inflammatory polyps, and gallstones) and neoplastic (adenoma, leiomyomas). The majority of lesions are nonneoplastic lesions; however, concerns of malignancy (adenocarcinoma) should not be underestimated. An accurate early diagnosis is essential to achieve good therapeutic outcomes, because overall prognosis for gallbladder cancer is poor. Adjuvant chemo- and radiation therapies are notorious to have low response rates in biliary tract malignancies. These findings have caused surgical treatment as the only chance for cure in early-staged disease. An overall 5-year survival rate of approximately 0 to 10 per cent has been reported in patients who were diagnosed with gallbladder cancer.1 An association between large-sized gallbladder polyps and high incidence for development of gallbladder cancer is well known to general surgeons. This fact has led to the traditional recommendation of performing cholecystectomy for polyps greater than 10 mm. The incidence of malignancy in smaller polyps has not been adequately investigated and described in the literature. In the current era of minimal access surgery, we performed a review to evaluate whether laparoscopic cholecystectomy is potentially beneficial for polyps smaller than 10 mm. A systematic review of all English-language articles between 1995 and 2012 was conducted using PubMed and MEDLINE databases. Keywords used were gallbladder polyps, polypoid lesions of the gallbladder, gallbladder cancer, and cholecystectomy. The primary endpoints were detection rates using various radiologic modalities and histopathologic evidence of carcinoma in polyps smaller than 10 mm. A total of 13 studies were identified, which included 1882 patients.