Current considerations for the surgical management of gallbladder adenomas

Abstract

Gallbladder adenomas are rare lesions (0.5%) associated with potential malignant transformation, particularly with gallbladder adenomas that are ≥ 1 cm in size. Early detection and management are crucial for preventing lethal carcinoma development. These polyps can often be distinguished from the more often nonneoplastic cholesterol pseudopolyps (5%-10%), which are benign. Ultrasonography is the first-line tool for initial diagnosis and follow-up when indicated. The question is whether cholecystectomy is always necessary for all adenomas. The management of gallbladder adenomas is determined according to the size of the tumor, the growth rate of the tumor, the patient’s symptoms and whether risk factors for malignancy are present. Adenomas ≥ 1 cm in size, an age > 50 years and a familial history of gallbladder carcinoma are indications for immediate laparoscopic cholecystectomy. Otherwise, ultrasound follow-up is indicated. For adenomas 6-9 mm in size, the absence of ≥ 2 mm growth at 6 months, one year, and two years, as well as an adenoma sized < 5 mm without existing risk factors indicates that no further surveillance is required. However, it would be preferable to individualize the management in doubtful cases. Novel interventional modalities for preserving the gallbladder need further evaluation, especially to determine the long-term outcomes.

Keywords: Biliary diseases; True neoplastic polyps; Gallbladder adenomas; Benign biliary tumors; Gallbladder polyps; Extrahepatic biliary neoplasms

Core Tip: Gallbladder adenomas are rare benign neoplastic lesions associated with malignant potential. Thus, early management is essential to prevent transformation. They are usually detected incidentally by imaging. Current imaging modalities can ensure a reliable diagnosis in vague cases. The management includes either laparoscopic cholecystectomy or ultrasound surveillance.