DOI: http://dx.doi.org/10.18203/2349-2902.isj20205367

Clinicopathological study of gall bladder carcinoma with special reference to its management in a tertiary care hospital

Debmalya Saha, Saket Jha, Sukalyan Chhaule, Rabin Mandal, Anadi Acharya, Gautam Ghosh

Abstract


Background: Incidence of gallbladder carcinoma is increasing progressively among Indians and is regarded as a major cause of mortality and morbidity. In spite of this, limited studies have been conducted so far. Objective of the study was to know the prevalence, clinicopathological aspects, and prevalent treatment protocol of gall bladder cancer in a tertiary care hospital in Eastern India.

Methods: 64 cases of histologically proven gallbladder cancer patients were studied. Patient characteristics were recorded using pretested proforma along with relevant investigations, and histopathology and treatment provided were recorded.

Results: Our study reveals that gallbladder cancer has a prominent peak in the 7th decade of life with male: female ratio of 1:2.2. Most of the patients were having body mass index between 20.0 and 24.99, which is in sharp contrast to the available literatures. Pain is the most common symptom followed by constitutional symptoms. Majority of cases presented at advanced stage (64.1%) with significantly elevated CA19.9 level, and were managed with palliative chemotherapy.35.9% of our cases were respectable at the time of diagnosis, and extended cholecystectomy could be performed in 31.3%. Log rank test showed pattern of survival of the patients who were resected was significantly better than those of who were not resected.

Conclusions: We know gallbladder cancer is a disease with very few patients amenable to surgery at the time of presentation. Thus, instead of retrospectively analyzing individual institutional data, high volume institutions with the necessary expertise for treating gallbladder cancer should collaborate with a view of generating strong evidence-based surgical guidelines.


Keywords


Cancer, Carcinoma, Gallbladder, Stage

Full Text:

PDF

References


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

Orth K, Berger HG. Gallbladder carcinoma and surgical treatment. Langenbecks Arch Surg. 2000;382:501-8.

Carriaga MT, Henson DE. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer. 1995;75:171.

Kiran RP, Pokala N, Dudrick SJ. Incidence pattern and survival for gallbladder cancer over three decades--an analysis of 10301 patients. Ann Surg Oncol. 2007;14:827.

Yang JD, Kim B, Sanderson SO. Biliary tract cancers in Olmsted County, Minnesota, 1976-2008. Am J Gastroenterol. 2012;107:1256.

Diehl AK. Epidemiology of gallbladder cancer: a synthesis of recent data. J Natl Cancer Inst. 1980;65:1209.

Indian Council of Medical Research (ICMR) Annual report of population-based cancer registries of the National Cancer Registry Program (1993), (1996). New Delhi: ICMR publication.

Randi G, Franceschi S, Vecchia C. Gall bladder Cancer worldwide: Geographical distribution and Risk Factors. Int J Cancer. 2006;118:1591-602.

Pandey M, Gautam A, Shukla VK. ABO and Rh blood groups in patients with cholelithiasis and carcinoma of the gallbladder. BMJ. 1995;310:1639

Shukla VK, Singh H, Pandey M, Upadhyay SK, Nath G. Carcinoma of the gallbladder: is it a sequel of typhoid. Dig Dis Sci. 2000;45:900-3.

Singh S, Sah S, Shukla VK. Cytochrome P-450: its association with lipid peroxidation and gallbladder carcinogenesis. Cancer J. 1998;11:315-7.

Piehler JM, Crechlow RW. Primary carcinoma of the gallbladder. Surg Gynecol Obstet. 1978;146:929-42.

Ritts RE, Nagomey DM, Jacobson DJ. Comparison of preoperative CA 19-9 levels with result of diagnostic imaging modalities in patients undergoing laparotomy for suspected pancreatic or gall bladder disease. Pancreas. 1994;9:707-16.

Lee SE, Jang JY, Lim CS, Kang MJ, Kim SW. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol. 2011;17:174-80.

Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg. 2009;33:2657-63.

Isambert M, Leux C, M├ętairie S, Paineau J. Incidentally discovered gallbladder cancer: When, why and which reoperation? J Visc Surg. 2011;148:77-84.

Kohya N, Miyazaki K. Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol. 2008;97:498-502.

Miyakawa S, Ishihara S, Horiguchi A, Takada T, Miyazaki M, Nagakawa T. Biliary tract cancer treatment: 5,584 results from the biliary tract cancer statistics registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreatic Surg. 2009;16:1-7.

Lim CS, Jang JY, Lee SE, Kang MJ, Kim SW. Reappraisal of hepatopancreatoduodenectomy as a treatment modality for bile duct and gallbladder cancer. J Gastrointestinal Surg. 2012;16:1012-8.

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

Choi ST, Hwang S, Lee SG, Lee YJ, Park KM, Kim KH, et al. Prognosis of patients with the gallbladder carcinoma undergone laparoscopic cholecystectomy as an initial operation. J Korean Surg Soc. 2003;65:140-4.

Goetze TO, Paolucci V. Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry. Surg Endosc. 2008;22:2462-5.

Goetze TO, Paolucci V. Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry. Surg Endosc. 2010;24:2156-64.

Macdonald OK, Crane CH. Palliative and postoperative radiotherapy in biliary tract cancer. Surg Oncol Clin N Am. 2002;11:941-54.

Kim WS, Choi DW, You DD, Ho CY, Heo JS, Choi SH. Risk factors influencing recurrence, patterns of recurrence, and the efficacy of adjuvant therapy after radical resection for gallbladder carcinoma. J Gastrointest Surg. 2010;14:679-87.