NEW YORK (Reuters Health) Oct 24 - Calcification of the gallbladder wall is historically linked to a high risk of gallbladder cancer but a contemporary review finds the association is weak at best.
"Prophylactic cholecystectomy is not indicated for PGB (porcelain gallbladder) alone and should be performed only in patients with conventional indications for cholecystectomy," the authors of a report this month in Archives of Surgery conclude.
Studies published 50 years ago described an incidence of cancer exceeding 60% in cases of porcelain gallbladder, said senior author Dr. Sergio Huerta, with the Veterans Affairs North Texas Health Care System in Dallas, and colleagues.
But what is called porcelain gallbladder these days differs from what it was decades ago, because modern diagnostic tools are much more sensitive than plain film x-rays, they point out. As a result, recent reports have indicated that the relationship of gallbladder calcification to cancer is not clearcut.
Their new data are drawn from the medical records on 1,200 cholecystectomies done between 2008 and 2009. Thirteen patients had porcelain gallbladder (1.1%), and none of them had any evidence of cancer.
Furthermore, in 35 cases of gallbladder cancer seen between 1997 and 2009, none had gallbladder wall calcification, the authors report.
They also undertook a systematic review of the literature on the topic. In a total of 60,665 cholecystectomies, there were 140 porcelain gallbladders (0.2%) and 21 of these cases involved gallbladder cancer - most of which were reported in the older literature, Dr. Huerta and colleagues report.
"In conclusion, our analysis shows that the risk for gallbladder cancer in PGB is very remote," they write. "Recognizing a substantially low risk, observation might be adequate for the vast majority of these patients."
SOURCE: http://bit.ly/v6pY1f
Arch Surg 2011;146:1143-1147.
"Prophylactic cholecystectomy is not indicated for PGB (porcelain gallbladder) alone and should be performed only in patients with conventional indications for cholecystectomy," the authors of a report this month in Archives of Surgery conclude.
Studies published 50 years ago described an incidence of cancer exceeding 60% in cases of porcelain gallbladder, said senior author Dr. Sergio Huerta, with the Veterans Affairs North Texas Health Care System in Dallas, and colleagues.
But what is called porcelain gallbladder these days differs from what it was decades ago, because modern diagnostic tools are much more sensitive than plain film x-rays, they point out. As a result, recent reports have indicated that the relationship of gallbladder calcification to cancer is not clearcut.
Their new data are drawn from the medical records on 1,200 cholecystectomies done between 2008 and 2009. Thirteen patients had porcelain gallbladder (1.1%), and none of them had any evidence of cancer.
Furthermore, in 35 cases of gallbladder cancer seen between 1997 and 2009, none had gallbladder wall calcification, the authors report.
They also undertook a systematic review of the literature on the topic. In a total of 60,665 cholecystectomies, there were 140 porcelain gallbladders (0.2%) and 21 of these cases involved gallbladder cancer - most of which were reported in the older literature, Dr. Huerta and colleagues report.
"In conclusion, our analysis shows that the risk for gallbladder cancer in PGB is very remote," they write. "Recognizing a substantially low risk, observation might be adequate for the vast majority of these patients."
SOURCE: http://bit.ly/v6pY1f
Arch Surg 2011;146:1143-1147.
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