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Kousgaard N, Rasmussen SKM, Möller S, Koulaouzidis A, Mark-Christensen A. Symptomatic uncomplicated gallstone disease is associated with a high short-term risk of gallstone-related complications: a contemporary cohort study. Scand J Gastroenterol 2024; 59:954-960. [PMID: 38950569 DOI: 10.1080/00365521.2024.2361756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The natural history of symptomatic uncomplicated gallstone disease is largely unknown. We examined the risk of progressing from symptomatic uncomplicated to complicated gallstone disease in a large regional cohort of patients, where disruptions in elective surgical capacities have led to the indefinite postponement of surgery for benign conditions, including cholecystectomies. METHODS Patients with radiologically diagnosed incident symptomatic and uncomplicated gallstone disease were identified from outpatient clinics and emergency departments on the Island of Funen, Denmark. The absolute risk of complications (cholecystitis, cholangitis, pancreatitis, acute cholecystectomy for unremitting pain) was calculated using death and elective cholecystectomies as competing risks using the Aalen-Johansen method. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) of gallstone complications associated with patient and gallstone characteristics. RESULTS Two hundred eighty-six patients diagnosed with incident symptomatic, uncomplicated gallstone disease from 1 January 2020 to 1 July 2023 were identified. During 79,170 person-years of observation, 176 (61.5%) patients developed a gallstone-related complication. The 6-, 12- and 24-month risk of developing gallstone-related complications were 36%, 55% and 81%. The risk of developing complications related to common bile duct stones was lowest with larger stones (aHR per millimeter increase = 0.89 (0.82-0.97), p < 0.01), while no covariates were statistically significantly associated with the risk of cholecystitis. Eighty-five (30%) patients underwent elective laparoscopic cholecystectomy, with one patient (1.2%) developing a gallstone-related complication afterward. CONCLUSIONS The risk of developing complications to symptomatic gallstones in a general Scandinavian population is high, and prophylactic cholecystectomy should be considered.
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Affiliation(s)
- Nivi Kousgaard
- Department of Clinical Medicine, University of Southern Denmark, Denmark
| | | | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital and Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Denmark
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Aloraini, A, Alshehri K, Alshammari, R, Bin Onayq, A, Ayesh, M, Alzahrani, M, AlShammari, SA, Alsaif, F. Late port-site metastasis of unexpected gallbladder carcinoma after laparoscopic cholecystectomy: A case report. Medicine (Baltimore) 2024; 103:e37880. [PMID: 38701302 PMCID: PMC11062704 DOI: 10.1097/md.0000000000037880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Incidental gallbladder carcinoma refers to a discovery of gallbladder cancer during or after cholecystectomy. Late port-site metastasis (PSM) following Laparoscopic cholecystectomy (LC) is rare with an incidence rate of 10.3%. PATIENT CONCERNS We report a case of a 58-year-old man who presented with a painful abdominal wall mass for 6 weeks. He had a history of LC for symptomatic cholelithiasis, 8 years prior. DIAGNOSIS Histopathological examination revealed a positive result for metastatic adenocarcinoma from the abdominal wall mass. Moreover, Positron emission tomography (PET) showed a small focus of intense fluorodeoxyglucose (FDG) uptake in the gallbladder bed, which was highly suspicious for malignancy. INTERVENTION Decision was to proceed with surgery owing to uptake in the gallbladder bed with single-site metastasis to the previous port site. In addition, in the board meeting, an agreement was reached for performing distal pancreatectomy with splenectomy owing to uncertainty of malignancy based on what was discovered during the full metastatic workup. Diagnostic laparoscopy followed by midline laparotomy performed. Radical completion cholecystectomy with lymphadenectomy was done. Followed by complete resection of the anterior abdominal wall. Distal pancreatectomy and splenectomy were then performed. OUTCOME Pathological diagnosis showed metastatic/invasive, moderately differentiated adenocarcinoma with positive margins on the posterior surface of excised port-site mass. The positive margins necessitated further chemoradiotherapy, followed by adjuvant chemotherapy until lung metastasis was identified. After this, the patient was scheduled for palliative chemotherapy. CONCLUSION Presence of PSM is often associated with peritoneal metastasis. For this reason, it is advised to evaluate the patient for possible metastasis.
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Affiliation(s)
- Abdullah Aloraini,
- General, HPB & Transplant Surgeon, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Alshehri
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rahaf Alshammari,
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhakim Bin Onayq,
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Ayesh,
- Department of Radiology, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Malak Alzahrani,
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman A. AlShammari,
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alsaif,
- General, HPB & Transplant Surgeon, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Hacihasanoglu E, Pasaoglu E, Cin M, Yarikkaya E, Dursun N, Baykal Koca S. Can the sampling method affect the detection of incidental gallbladder carcinoma? Comparative analysis of two sampling methods. Ann Diagn Pathol 2023; 67:152187. [PMID: 37625264 DOI: 10.1016/j.anndiagpath.2023.152187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Ezgi Hacihasanoglu
- Department of Pathology, Yeditepe University School of Medicine, Istanbul, Turkiye
| | - Esra Pasaoglu
- Department of Pathology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkiye
| | - Merve Cin
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
| | - Enver Yarikkaya
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
| | - Nevra Dursun
- Department of Pathology, University of Health Sciences, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkiye.
| | - Sevim Baykal Koca
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
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4
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Feo CF, Ginesu GC, Fancellu A, Perra T, Ninniri C, Deiana G, Scanu AM, Porcu A. Current management of incidental gallbladder cancer: A review. Int J Surg 2022; 98:106234. [PMID: 35074510 DOI: 10.1016/j.ijsu.2022.106234] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023]
Abstract
Early-stage gallbladder cancer (GBC) is mostly discovered incidentally by the pathologist after cholecystectomy for a presumed benign disease. It is the most common malignancy of the biliary tract with a variable incidence rate all over the World. The majority of patients with GBC remain asymptomatic for a long time and diagnosis is usually late when the disease is at an advanced stage. Radical surgery consisting in resection of the gallbladder liver bed and regional lymph nodes seems to be the best treatment option for incidental GBC. However, recurrence rates after salvage surgery are still high and the addition of neoadjuvant/adjuvant chemotherapy may improve outcomes. The aim of the present review is to evaluate current literature for advances in management of incidental GBC, with particular focus on staging techniques and surgical options.
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Affiliation(s)
- Claudio F Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
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5
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Echelard P, Roy SF, Trinh VQH, Garant MP, Collin Y, Nguyen BN, Geha S. Age, operation time and surgical approach can be used to detect incidental gallbladder carcinoma in cholecystectomy specimens from low-incidence settings. Histopathology 2021; 79:667-673. [PMID: 34061406 DOI: 10.1111/his.14423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022]
Abstract
AIMS Gallbladders resected for non-neoplastic diseases are systemically examined microscopically to rule out incidental dysplasia and carcinoma. The main aim of this study was to test whether a pre-grossing algorithm can detect incidental gallbladder carcinoma. The secondary aim was to test whether the algorithm can detect high-grade dysplasia. METHODS AND RESULTS A retrospective study of clinical, pathological and radiological findings in cholecystectomy recipients was performed on a test set to develop a classification and regression tree algorithm. Cholecystectomy cases were included; exclusion criteria were age <18 years, missing pathology reports, preoperative suspicion of neoplastic disease, and cholecystectomy for non-gallbladder oncological disease. Five thousand nine hundred and eighty-two cholecystectomies from 2006 to 2018 were included in the study, with 18 cases of incidental gallbladder carcinoma and 11 cases of high-grade dysplasia. Three hundred and ninety controls were randomly selected for the testing set. Patient age, surgical approach, operation duration, dilatation of the biliary tract and gallbladder gross anomalies were statistically significant distinguishing factors in multivariate analysis (P < 0.00-0.026). Unsupervised testing with a conditional inference tree suggested that age, procedure type and operation duration can be used to identify incidental gallbladder carcinoma from controls, whereas high-grade dysplasia also requires grossing parameters to identify half of the cases (5/11). CONCLUSION Readily available clinical parameters and postoperative data can be used to detect incidental gallbladder carcinoma. High-grade dysplasia mostly requires grossing and microscopic examination.
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Affiliation(s)
- Philippe Echelard
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada
| | - Simon F Roy
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Q-H Trinh
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Yves Collin
- Department of Surgery, University of Sherbrooke, Sherbrooke, Canada
| | - Bich N Nguyen
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Sameh Geha
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada
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6
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Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, Tanis PJ, Bemelman WA. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg 2020; 107:1414-1428. [PMID: 32639049 PMCID: PMC7540681 DOI: 10.1002/bjs.11759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.
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Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - J E Tuijp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - L Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis. J Clin Med 2020; 9:jcm9051484. [PMID: 32423156 PMCID: PMC7290945 DOI: 10.3390/jcm9051484] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to determine the incidence and the prognosis of incidental carcinoma of the gallbladder (IGBC) after cholecystectomy through a meta-analysis. This meta-analysis included 51 studies and 436,636 patients with cholecystectomy. The incidence rate of IGBC after cholecystectomy was 0.6% (95% confidence interval (CI) 0.5%-0.8%). The incidence rate of recent studies was not significantly different from those of past studies. The mean age and female ratio of the IGBC subgroup were not significantly different from those of the overall patient group. The estimated rates of IGBC were 13.0%, 34.1%, 39.7%, 22.7%, and 12.5% in the pTis, pT1, pT2, pT3, and pT4 stages, respectively. Patients with IGBC had a favorable overall survival rate compared to patients with non-IGBC (hazard ratio (HR) 0.574, 95% CI 0.445-0.739). However, there was no significant difference of disease-free survival between the IGBC and non-IGBC subgroups (HR 0.931, 95% CI 0.618-1.402). IGBC was found in 0.6% of patients with cholecystectomy. The prognosis of patients with IGBC was favorable compared to those with non-IGBC. In the pathologic examination after cholecystectomy for benign diseases, a sufficient examination for histology should be guaranteed to detect IGBC.
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8
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Firat YD, Idiz UO, Cakir C, Yardimci E, Yazici P, Bektasoglu H, Bozkurt E, Ucak R, Gucin Z, Uresin T, Hasbahceci M. Prospective multi-center study of surgeon's assessment of the gallbladder compared to histopathological examination to detect incidental malignancy. Langenbecks Arch Surg 2019; 404:573-579. [PMID: 31297608 DOI: 10.1007/s00423-019-01800-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Routine histopathological examination after cholecystectomy for gallstones is performed despite the low rates of incidental findings of malignancy. The aim of this study was to assess predictive values of macroscopic examination of cholecystectomy specimens by surgeons in gallstone disease. METHODS A prospective multi-center diagnostic study was carried out between December 2015 and March 2017 at four different centers. All patients undergoing cholecystectomy for gallstone disease were consecutively screened for eligibility. Patients whose ages are 18 to 80 years, and preoperative imaging findings without any pathology except cholelithiasis were included. The gallbladder was first evaluated macroscopically ex situ by two operating surgeons and rated as macroscopically benign (group S1), suspicious for a benign diagnosis (group S2), and suspicious for malignancy (group S3). Thereafter, a pathologist made a final histopathological examination whose results are grouped as chronic cholecystitis (group P1), benign or precancerous lesions in which only cholecystectomy is the adequate treatment modality (group P2), and carcinoma (group P3). Diagnostic accuracy of the surgeon's assessment to the histopathological examination was evaluated using sensitivity, specificity, positive and negative predictive values, and accuracy, and correlated by a kappa agreement coefficient. RESULTS A total of 1112 patients were included in this trial. The specificity rates were 96.5%, 100%, and 98.7% for group S1-group S2, group S1-group S3, and group S2-group S3, respectively. Accuracy rates to detect malignancy were 100% and 95. 2% for group S1 and group S2, respectively. Kappa coefficient values were 1.0 and 0.64 for group S1-group S3 and group S2-group S3, respectively (p < 0.001 for both). CONCLUSION Assessment of the gallbladder specimen and selective histopathological examination may be adequate after cholecystectomy for gallstone diseases. Such a procedure would have the potential to reduce costs and prevent unnecessary loss of labor productivity without affecting patients' safety. However, higher number of patients in more centers is needed to confirm this hypothesis.
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Affiliation(s)
- Yurdakul Deniz Firat
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ufuk Oguz Idiz
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Coskun Cakir
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Erkan Yardimci
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Pinar Yazici
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Bektasoglu
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Emre Bozkurt
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Ucak
- Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Gucin
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| | - Taskin Uresin
- Department of Pathology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mustafa Hasbahceci
- General Surgery Clinic, Medical Park Fatih Hospital, Fatih, Istanbul, Turkey
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Soleimani N, Pakbaz S. A Shot That Hits the Tumor: Incidental Finding of Early Colon Cancer in a Gunshot Wound Specimen-The Role of Pathologic Examination. Case Rep Pathol 2019; 2019:8059346. [PMID: 31139484 PMCID: PMC6500605 DOI: 10.1155/2019/8059346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/10/2019] [Accepted: 03/31/2019] [Indexed: 11/17/2022] Open
Abstract
This report presents incidental finding of early colorectal cancer in an adult patient with gunshot injury. The patient was a 41 y/o man, transferred to our center due to gunshot wound to his abdomen and back. A well differentiated adenocarcinoma, stage I, was incidentally identified during pathologic examination on his segmental proctectomy specimen. This singular case highlights the necessity of caring for all removed tissues, indicating how important they are for both clinicians and pathologists.
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Affiliation(s)
- Neda Soleimani
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Pakbaz
- Department of Pathology, Toronto General Hospital, University of Toronto, Canada
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Koppatz H, Nordin A, Scheinin T, Sallinen V. The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens. HPB (Oxford) 2018; 20:456-461. [PMID: 29248400 DOI: 10.1016/j.hpb.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/11/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cholecystectomy is usually carried out for benign indications. Most perform routine histopathologic examination to detect incidental gallbladder cancer (GBC). METHODS Cholecystectomies performed at four hospitals in the Helsinki Metropolitan Area during 2010-2012 were analyzed retrospectively. Patients with preoperative suspicion of neoplasia, active malignancy, or in whom cholecystectomy was performed as a secondary procedure were excluded. RESULTS A total of 2034 cholecystectomies were included. In ten patients (0.5%), GBC was identified, each with an associated macroscopic finding, including local hardness (n = 1), a thickened wall (n = 5), acute inflammation and necrosis (n = 1), or suspected neoplasia (n = 3). No GBC was found in macroscopically normal gallbladders (n = 1464). Of the ten patients with GBC, five underwent subsequent liver resection, four had metastatic disease, and one had locally advanced inoperable disease. Three of the five patients who underwent liver resection were alive and disease-free at final follow-up (median 48 months). The remaining seven patients with GBC died of the disease, with a median survival of 14 months (range 10-48 months). CONCLUSIONS Routine histopathologic examination of a macroscopically normal gallbladder does not improve diagnosis of GBC. A histopathological examination is, however, mandatory when a macroscopic abnormality is present.
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Affiliation(s)
- Hanna Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tom Scheinin
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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11
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Incidental gallbladder cancer: Review of 3856 cholecystectomies. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.414185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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