Surgical Outcomes and Risk Factors for Gallbladder Carcinoma of Polypoid Lesions of Gallbladder

ABSTRACT

PURPOSE: Most polypoid lesions of the gallbladder (PLGs) are benign, and laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high. PLGs were reviewed to identify risk factors for neoplastic polypoid lesions. METHODS: Between March 1992 and February 2005, 205 cases of PLGs, including 67 neoplastic and 138 nonneoplastic PLGs, were evaluated. Risk factors for neoplastic PLGs and gallbladder carcinomas were analyzed using multiple regression analysis. A receiver operating characteristics (ROC) curve was used to obtain a cut-off value of the tumor size and age of patients for predicting neoplastic PLGs and gallbladder carcinomas. RESULTS: The mean age of the patients, and the size, number and type of polyp were statistically different between 67 neoplastic (47 adenomas, 20 adenocarcinomas) and 138 nonneoplastic PLGs (104 cholesterol polyps, 22 hyperplastic polyps, 11 adenomyomas, and 1 xanthogranulomatous polyp). A multiple regression analysis showed that the size, number and type of polyp were significant risk factors for neoplastic PLGs. Of the 67 neoplastic PLGs, the age of the patient, and the size and type of polyp were significant risk factors of carcinomas. The sizes of tumors for predicting neoplastic PLGs and carcinomas were 0.85 and 1.1 cm, respectively, while the age for predicting a carcinoma was 55 years. In 5 carcinoma patients, an additional curative resection was performed. No recurrence or carcinoma related death were observed in the laparoscopic cholecystectomy (LC) only (15 cases) and additional surgery groups (5 cases). CONCLUSION: Risk factors of a carcinoma in PLGs include the age of the patients, and the size and sessile type of the PLG. The ROC curve showed that the appropriate size of the tumor and the age of the patient for predicting gallbladder cancer in PLGs were 1.1 cm and 55 years, respectively. Additional curative surgery immediately after an LC seems to increase the survival of gallbladder carcinoma patients, but its role should be determined through long term follow-up.