Comment on (Surgically Resected Gall Bladder: Is Histopathology Needed for All?)

I read with interest the manuscript by Talreja and colleagues [1] that questions the need for routine histopathological examination of the “apparently normal” gall bladder following cholecystectomy based on their retrospective examination of their data in which 11 patients (with gall bladder cancer) out of 964 (patients who underwent a cholecystectomy during the study period) had either preoperative imaging or intraoperatively visible gross features of wall thickening. This study is not the first [2] and it will certainly not be the last to raise this contentious issue. The problems with accepting the inferences of Talreja and colleagues are manifold. The first issue is that the authors themselves reported that only 55% of those with a cancer had suspicious thickening of the gall bladder on preoperative imaging. This means that 45% of patients with cancer were not detected on preoperative imaging. Secondly, only 6 patients (55%) with cancer had polypoidal lesions or ulcers in addition to thickening of the wall. This is in comparison to wall abnormalities being detected in 43% of the entire cohort! We are aware that the incidence of gall bladder cancer is not uniform around the world with some regions demonstrating a higher incidence than others [3]. However, we all agreed that the outcome of gall bladder is uniformly dismal irrespective of race, religion, or geographical location [3].