Gallbladder Cancer: A Hospital Based Study

Abstract

Introduction: Gallbladder carcinoma (GBC) is the commonest cancer of the biliary tree and the most frequent cause of death from biliary malignancies. The overall resection rates at presentation range from 10%-30% only. Therefore, a large number of patients are inoperable with overall survival of only 6-8 months. Palliation of the pain, jaundice, pruritus is a big challenge in patients with advanced disease.

Methods: A prospective cross sectional study of patients with GBC during the period of October 2014 to September 2017 at Nepalgunj Medical College and Teaching Hospital, Kohalpur, department of surgery.

Results: There were 216 cases of gastrointestinal malignancies with 54(25%) GBC. There was female (75.92%) preponderance with a male to female ratio of 1:3.15. The mean age was 61.41±12.18. The most common symptom at presentation was pain in a right upper abdomen (87.03%) followed by abdominal lump (41.23%) and surgical jaundice (18.51%). Fundus (70.37%) was the most common site of involvement followed by body (5.55%) and neck (24.05%). Gall stone was associated in 44 (81.48%) patients. Only 7 (12.96%) patients had localized GBC, 25 (46.29%) patients had locally advanced disease and 22 (40.74%) had metastatic disease. Liver was the commonest site of metastatis followed by peritoneum and two patients had left supraclavicular lymph node metastatis. There were two (3.72%) incidental gall bladder cancer after laparoscopic cholecystectomy. 13 (24.07%) patients were operated with intention of radical cholecystectomy but only six (46.15%) patient could undergo radical resection. Staging laparoscopy was done in all patients except for incidental gall bladder cancer. Metastatic disease was identified in 3 (23.07%) on staging laparoscopy. In eight (61.33%) among 13 patients the disease was unresectable. The most common histology was adenocarcinoma and most common stage was stage III and stage IV when both operated and non-operated groups were combined.

Conclusions: GBC was the commonest gastrointestinal tract cancer with a female preponderance. A majority of patients were inoperable at presentation with pain in abdomen being the most common symptom. Surgery although is the main stay of treatment is not possible in many.