Management Of Polypoid Lesion Of Gallbladder

Objective:Polypoid lesion of gallbladder(PLG) is a common but ignored founding in gallbladder while some surgeons prefer operation in most cases since the lack of the knowledge of PLG Now the surgical indication of PLG is controversial thus this study is aimed to investigate the risk factors of gallbladder neoplastic polyps in polypoid leision of gallbladder(PLG), clinical characteristics of gallbladder adenoma, and the feature of PLG patients with follow-up. Discuss and put forward rational surgical indication and follow-up strategy.Methods:Clinical data was retrospectively reviewed in816patients diagnosed as PLG before operation for treatment,748patients’clinical data were analyzed who had cholecystectomy with definite pathological diagnosis from January1998to December2012in the Second Affiliated Hospital of Zhejiang University School of Medicine. Then we put forward a rational management of PLG with a brief of literature.Results:748patients with an average age of44.49±11.62years old, the mean size of PLG was9.97±4.01mm.341had abdominal symptoms. According to pathological results, there were659non-neoplastic polyps,68gallbladder adenoma,15gallbladder cancer and6with no polyps postoperative with a diagnosis of chronic cholycystitis. The mean diameter of non-neoplastic lesions (9.38±3.44mm) was smaller than neoplastic polyps(14.55±5.71mm)(P<0.01).The difference of average age(44.14±11.42vs.49±12.82years) and proportion of solitary PLG(41.4%vs.59.59%) in non-neoplastic lesions and neoplastic polyps also had statistical significance (P<0.01). The size(13.34±4.18mm vs.20.07±8.19mm, P<0.05) and age(45.78±11.66years vs.54.13±15.82years, P<0.05) between gallbladder adenoma and gallbladder cancer were also statistically significant. Gallbladder adenoma or dysplasia was identified in66.7%(10/15) of gallbladder cancer specimens. The time interval from the diagnosis of PLG to surgery was shorter in neoplastic group (P<0.05), but the increased size of PLG, the growth rate of PLG and so on were otherwise not different with statistical significance.Conclusion:We suggest that PLG patients with abdominal symptoms, large size(≥10mm) are indicated for surgery; patients with risk factors like old age (≥50y), solitary polyp or coexistence may have a surgery after thoroughly discussion with patients, otherpatients should have long-term follow-up.