The Surgical Therapeutic Options for Polypoid Lesion of Gallbladder

Baik, Sang Hyun; Park, Hyung Seok; Kim, Seon Woo; Choi, Jae Young; Park, Yong Jin; Yoon, Myung Hee; Shin, Dong Hoon; Lee, Chung Han

Abstract

PURPOSE
Gallbladder polyps have malignant potentials and there are no definitive treatment criteria. Therefore, to establish the appropriate treatment for gallbladder polyps, the gross and microscopic appearance of gallbladder polyps were studied and the clinical findings analyzed. METHODS: Between January 1990 and December 1999, 1108 subjects underwent open and laparoscopic cholecystectomy at our institute. Seventy nine subjects, confirmed to have gallbladder polyps by pathology, were analyzed. To establish the surgical indications of polyps with malignancy potential, gender, age, clinical symptoms, polyp size, numbers, shape, coexistence of stones and the pathological findings were analyzed. RESULTS: The mean age of the subjects with benign and malignant polyps were 44.2 and 55.2 years old, respectively (p=0.034). The mean maximum diameter in benign and malignant polyps were 6.4 and 19.8 mm, respectively (p= 0.029). There were single polyps in 52.6 (30/57) and 86.3% (19/22) of the benign and malignant lesions, respectively (p= 0.046). Comparing the clinical symptoms (abdominal discomfort. etc) between the two groups, benign polyps had 26.3% (15/57), malignant polyps had 86.3% (19/22) (p= 0.0032). Cholesterol polyps were found in 29 (36.7%), inflammatory or hyperplastic polyps in 11 (13.9%) adenomas in 17 (21.5%) and adenocarcinomas in 22 (27.9%) cases. There were no differences in the presence of stones or in the shape of the polyps. CONCLUSION: On the basis of our analysis, when the polyp is of the single type, over 15 mm in diameter and the patient was 50 years old or over, surgical intervention should be considered due to the high risk of malignancy. If surgical intervention is not appropriated, a close follow-up is generally recommended to monitor the changes in the polyp size and shape.