Operative Criteria for Polypoid Lesions of the Gallbladder

Kim, Min Seok; Sim, Mun Sup

Abstract

BACKGROUND: There is no definite criteria for treatment of polypoid lesions of the gallbladders although they may have malignant potentials.
METHODS
Surgically resected polypoid lesions of the gallbladders of 68 patients who were treated at the Department of Surgery, Pusan National University Hospital, from Jan. 1986 to Dec. 1996 were evaluated based on the patients' sex and age, histologic results, and operative methods.
RESULTS
The numbers of each type of polypoid lesion of the gallbladder were 28 cases (41.2%) of cholesterol polyps, 6 cases (8.8%) of inflammatory polyps, 8 cases (11.8%) of gallbladder adenomas, and 26 cases (38.2%) of gallbladder cancers. Two histologic characteristics of an adenoma and a carcinoma in situ coexisted in two cases of gallbladder cancers, in another two cases, there were adenomatous residue in their tissues, and in four cases of gallbladder adenomas, the authors could identify intestinal metaplasia in the tissues. Thus, the probablility of the adenoma-carcinoma sequence was suspected because of these results. The cancer risk of gallbladder polyps increased propotionally with their sizes and was related with their shapes. In the sessile group, the mean maximal diameter was 8.2+/-3.4 mm in benign polyps and 31.8+/-11.9 mm in malignant polyps (p<0.005). In the pedunculated group, the mean maximal diameter was 9.8+/-6.3 mm in benign polyps and 34.8+/-13.9 mm in malignant polyps (p<0.005). The sizes of the gallbladder cancers were evenly distributed in the sessile group but in the pedunculated group there was only one case with a maximal diameter of 13.8 mm, all others were over 20 mm. In the age and the sex distributions, benign polyps were distributed mainly below 50 in both genders, but malignant polyps were distributed above an age of 50 in men and were evenly distributed in women of all ages.
CONCLUSIONS
The authors would recommend operations in case of the following: 1) age: above 50 in men, and all ages in women; and 2) size: above 10 mm the in pedunculated group, and above 5 mm in the sessile group.