Selective Rather Than Routine Histopathological Examination Following Appendectomy and Cholecystectomy
Selective Rather Than Routine Histopathological Examination Following Appendectomy and Cholecystectomy
The FANCY study will investigate whether a selective policy of histopathological examination
 of appendices and gallbladders based on the intraoperative findings of the surgeon is safe
 and cost-effective.
Traditionally, all surgically removed appendices and gallbladders are sent to the department
 of pathology for histopathological examination. This is most likely not necessary in
 appendices and gallbladders that are not suspicious for a tumour when inspected visually or
 by palpation. If not detected by visual inspection or palpation, the tumour is usually of
 early stage and already treated with the resection of the organ. A policy of selective
 histopathological examination based on the intraoperative findings of the surgeon can
 probably reduce the amount of appendices and gallbladders that have to be examined by the
 pathologist, without a risk of undertreatment, with less risk of overtreatment and huge
 savings annually. In the FANCY study, a nationwide prospective multicenter observational
 cohort study, all appendices and gallbladders will be evaluated for tumours by visual
 inspection and palpation by the operating surgeon. The operating surgeon will report his or
 her findings and also write down whether he or she thinks there is an indication for
 histopathological examination. Subsequently, all specimens are sent to the pathologist for
 histopathological examination. Therefore, no aberrant findings will be missed due to this
 study. The prospective cohort can be compared through modelling to a hypothetical situation
 where appendices and gallbladders are only examined by the pathologist on indication. The
 primary outcome is the number of patients per 1000 examined appendices/gallbladders with a
 neoplasm requiring additional therapy benefitting the patient that would have been unnoticed
 in the policy of selective histopathological examination.
Inclusion Criteria:

 -  Patients scheduled to undergo an appendectomy or cholecystectomy in the elective or
 non-elective setting.

 Exclusion Criteria:

 -  Primary indication for surgery: strong suspicion or proven malignancy in the appendix
 or gallbladder.

 -  Appendix or gallbladder removed as part of more extensive surgery, so-called
 incidental appendectomies or cholecystectomies.

 -  Patients included in the ACCURE trial (effect of appendectomy on ulcerative colitis).

 -  The presence of a gallbladder polyp of >10 mm on preoperative imaging.