Surgical treatment of xanthogranulomatous cholecystitis: a report of 56 patients

Objective To study the surgical treatment of xanthogranulomatous cholecystitis (XGC). Methods We retrospectively analyzed the clinical data of 56 patients with XGC who underwent surgical treatment at the Zhejiang Provincial People’s Hospital from May 2010 to May 2017. Results The diagnosis of XGC was confirmed by histopathology. On preoperative examination of the 56 patients, 42 patients had various degrees of increase in the CA19.9 levels, 41 patients (73.2%) had thickened gallbladder walls with continuous mucosal linings on ultrasonography, CT, or MRI, and 18 patients (32.1%) had thickening of gallbladder walls with low density nodules. Gallbladder stones were present in 51 patients (91.1%) and 4 patients (7.2%) presented with Mirizzi syndrome. The 41 patients (73.2%) who were diagnosed as XGC before operation under laparoscopic surgery and 7 patients (17.1%) were converted to open surgery. The remaining 15 patients (26.8%) underwent open operation directly because of uncertainty in the diagnosis. All the patients had frozen section during operation. The postoperative pathological results included 21 localized type (37.5%) and 35 diffuse type (62.5%) of XGC. All 56 patients had no long-term complications on followed-up for 0.5~6 years. Conclusions XGC is a special kind of chronic cholecystitis. There is difficulty in differentiating from gallbladder cancer before surgery. The diagnosis of XGC mainly depends on ultrasonography, CT or MRI. Cholecystectomy is the treatment for XGC. Laparoscopic surgery is the first line treatment for XGC. Key words: Xanthogranulomatous cholecystitis (XGC); Gallbladder cancer; Laparoscopy; Cholecystectomy