DOI: http://dx.doi.org/10.18203/2349-2902.isj20192059

Carcinoma of the gall bladder: 8 year experience from a tertiary care centre, Punjab, India

Mohit Sharma, Rachhpal Singh

Abstract


Background: Gall bladder carcinoma is the most common malignancy of biliary tract and one of the most aggressive gastrointestinal malignancies. The present study was conducted to know the clinical aspects, results and survival patterns after therapeutic interventions in patients of gall bladder cancer.

Methods: The study is retrospective analysis of prospectively collected data of gall bladder cancer patients.

Results: In 288 gall bladder cancer patient’s median age was 60 yrs. There were 219 females, 69 males (F:M=3.2:1). Median number of days from the onset of symptoms to presentation was 24.5 days. Majority of patients were stage IVB 162 (56.3%), least were stage I 3(1%). 192 (66.7%) patients received palliative treatment because of unresectable malignancy. 39 (13.5%) patients underwent noncurative surgical intervention. 57 (19.8%) patients underwent extended cholecystectomy. The median number of lymph nodes detected on histopathological examination was 4.5 (range 3-12). 21 patients (36.8%) had positive lymph nodes. Median follow up of all patients was 6 months (1-66 months). 27 (9.4%) patients survived till last date of follow up. Median survival time in groups undergoing extended cholecystectomy, noncurative surgery, chemotherapy alone was 12, 8 and 4 months respectively. The difference in median survival time between the groups was statistically significant, Log rank (Mantel-Cox) χ2=109.78, p=0.00.

Conclusions: Carcinoma of the gall bladder predominately affects females. Majority of patients had delayed presentation, stage IVB. Extended cholecystectomy is the only effective treatment to achieve long term survival.

 


Keywords


Gallbladder cancer- Punjab- India, Extended cholecystectomy, Outcomes, Survival analysis

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References


Donohue JH, Stewart AK, Menck HR. The National cancer Data Base report on carcinoma of the gall bladder, 1989-1995. Cancer. 1998;83(12):2618-28.

Henson DE, Albores-Saaverda J, Corle D. Carcinoma of the gall bladder. Histologic types, stage of disease, grade and survival rates. Cancer. 1992;70:1493-7.

Sharma MK, Singh T, Pandey AK, Kankaria A. Epidemological trends of GI cancers in patients, visiting a tertiary care hospital in Chandigarh, North India. Asian Pac J Cancer Prev. 2015;16(8):3499-503.

Aggarwal R, Manuja, Aditya K, Singh GPI. Pattern of cancer in a tertiary care hospital in Malwa region of Punjab, in comparison to other regions in India. J Clin Diag Res. 2015;9(3):5-7.

Pandey M, Pathak AK, Gautam A, Aryya NC, Shukla VK. Carcinoma of the gallbladder: a retrospective review of 99 cases. Dig Dis Sci. 2001;46:1145-51.

Murthy NS, Rajaram D, Gautham MS, Shivraj NS, Pruthvish S, George PS, Mathew A. Trends in incidence of Gall bladder cancer-d Indian scenario. Gastrointest Cancer. 2011;1:1-9.

Hamadani NH, Qadri SK, Aggarwalla R, Bhartia VK, Chaudhuri S, Debakshi S, et al. Clinico-pathological study of Gall bladder carcinoma with special reference to Gall stones: Our 8 year experience from Eastern India. Asian Pacific J Cancer Prev. 2012;13(11):5613-7.

Shukla VK, Khandelwal C, Roy SI, Vaidya MP. Primary carcinoma of the gall bladder: a review of a 16 year period at the University hospital. J Surg Oncol. 1985;28:32-5.

Batra Y, Pal S, Dutta U, Desai P, Garg PK, Makharia G, et al. Gall bladder cancer in India: a dismal picture. J Gastroenterol Hepatol. 2005;20:309-14.

Kapoor VK, McMichael AJ. Gallbladder cancer: An Indian disease. Natl Med J Ind. 2003;16:209-13.

Goyal G, Narayan KS, Gupta GK, Nijhawan S. Carcinoma of gall bladder: Clinical evaluation and survival rate at a tertiary care center in Rajasthan. Indian J Gastroenterol. 2017;36(4):326.

Sachidananda S, Krishnan A, Janani K, Alexander PC, Velayutham V, Rajagopal S, Venkataraman J. Characteristics of Gall bladder cancer in South India. Indian J Surg Oncol. 2012;3:228-30.

Toyongal T, Chijiiwa K, Nakano K, Noshiro H, Yamaguchi K, Sada M, et al. Completion radical surgery after cholecystectomy for accidentally undiagnosed gall bladder carcinoma. World J Surg. 2003;27:266-71.

Koga A, Watanabe K, Fukuyama T, Takiguchi S, Nakayama F. Diagnosis and operative indications for polypoid lesions of the gall bladder. Arch Surg. 1988;123:26-9.

Nakamura S, Sakaguchi S, Suzuki S, Muro H. Aggressive surgery for carcinoma of the gall bladder. Surgery. 1989;106:467-73.

Pradeep R, Kaushik SP, Sikora SS, Battacharya BN, Pandey CM, Kapoor VK. Predictors of survival in patients with carcinoma of the gall bladder. Cancer. 1995;76:1145-9.

Singh SK, Talwar R, Kannan N, Tyagi AK, Jaiswal P, Kumar A. Aggressive surgical approach for gall bladder cancer: a single center experience from Northern India. J Gastrointest Cancer. 2015;46(4):399-407.

Tsukada K, Kurodali I, Uchida K, Shirai Y, Oohashi Y, Yoloyama N, et al. Lymph node spread from carcinoma of the gall bladder. Cancer. 1997;80:661-7.

Todoroki T, Kawamoto T, Takahashi H, Talada YM Koike N, Otsuka M et al. Treatment of gallbladder cancer by radical resection. Br J Surg. 1999;86:622-7

Sakata J, Shirai Y, Wakai T, Ajioks Y, Hatakeyamaa K. Number of positive lymph nodes independently determined the prognosis after resection in patients with gall bladder Carcinoma. Ann Surg Oncol. 2010;17:1831-40.

Amini N, Kim Y, Wilsom A, Margonis GA, Ethun CG, Poultsides G, et al. Prognostic implications of lymph node status for patients either gallbladder cancer: A multi-institutional study. Ann Surg Oncol. 2016;23:3016-23.

Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH. et al. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci. 2014;29:1333-40.

Ito H, Ito K, D’Angelica M, Gonen M, Klimstra D, Allen P, et al. Accurate staging for gall bladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254:320-5.

Tewari M, Kumar S, Shukla S, Shukla HS. Analysis of wedge resection of gall bladder bed and lymphadenectomy on adequate oncologic clearance for gall bladder cancer. Indian J Cancer. 2018;124:253-67.

Patkar D, Ostwal V, Ramaswamy A, Engineer R, Chopra S, Shetty N, Dusane R, Shriikhande SV, Goel M. Emerging role of multimodality treatrment in gall bladder cancer: Outcomes following 510 consecutive resections in a tertiary referral center. J Surg Oncol. 2018;117(3):372-9.

Hyder O, Dodson RM, Sachs T, Weiss M, Mayo SC, Choti MA, et al. Impact of adjuvant external beam radiotherapy on survival in surgically resected gall bladder Adenocarcinoma: a propensity score matched Surveillance Epidemiology and End Result analysis. Surgery. 2014;155:85-93.

Hoehn RS, Wima Koffi, Ertel AE. Adjuvant therapy for gall bladder cancer: An analysis of national cancer database. J Gastrointest Surg. 2015;19:1794-801.

Agarwal S, Mohan L, Mourya C, Neyaz Z, Saxena R. Radiological downstaging with neoadjuvant therpay in uneresecable gall baldder cancer cases. Asian Pac J Cancer Prev. 2016;17(4):2137-40.

Engineer R, Goel M, Chopra S, Patil P, Purandare N, Rangarajan V, et al. Neoadjuvant chemoradiation followed by surgery for locally advanced gall bladder cancers: A new paradigm. Ann Surg Oncol. 2016;23:3009-15.