Pathological examination after appendectomy and cholecystectomy
– The fourth Dutch Snapshot study –
Traditionally, all surgically removed appendices and gallbladders are sent to the department of pathology for histopathological examination. This is most likely not necessary in appendices and gallbladders that are not suspicious for a tumour when inspected visually or by palpation. If not detected by visual inspection or palpation, the tumour is usually of early stage and already treated with the resection of the organ. A policy of selective histopathological examination based on the intraoperative findings of the surgeon can probably reduce the amount of appendices and gallbladders that have to be examined by the pathologist, without a risk of undertreatment, with less risk of overtreatment, and major savings annually.
The objective is to investigate the oncological safety and potential cost savings of selective histopathological examination following appendectomy and cholecystectomy.
All appendices and gallbladders will be prospectively evaluated for tumours by the operating surgeon by visual inspection and digital palpation of the specimen. The appendix will not be opened. The galbladder is opened in its length, without cutting the ductus cysticus. The surgeon will report his findings on a predefined scoring form: he or she will report all abnormalities and writes down whether he or she considers there is an indication for histopathological examination. Subsequently, all specimens will be sent for histopathological examination. Therefore, no aberrant findings will be missed due to this study. The prospective cohort can be compared through modelling to a hypothetical situation where appendices and gallbladders are only examined by the pathologist on indication.
Patients of all ages who are scheduled to undergo an appendectomy or cholecystectomy in the elective or non-elective setting.
1) Number of patients per 1000 examined appendices/gallbladders with a neoplasm requiring additional therapy or follow-up benefitting the patient that would have been unnoticed in case of selective histopathological examination.
2) Costs of the two different policies (selective vs routine histopathological examination).
The study is currently performed in 60 out of 76 Dutch hospitals. All hospitals are including patients over a period of 9 months. Since May 2018, every month a group of hospitals were opened for inclusion after ethics were approved and a site initiation visit was performed. The last group of hospitals started on 1 November 2018 and will be finished on 1 September 2019. After a period of data cleaning and analysis, the first results are expected in the 2020.