A prospective study of radical cholecystectomy for gallbladder carcinoma
Background: Gallbladder cancer tends to be an aggressive tumor that spreads early and leads to rapid death. The clinical pessimism surrounding gallbladder cancer is because of its late presentation and lack of effective therapy. Definitive resection for Gallbladder cancer depends on stage and location of the tumour as well as whether it is repeat resection after a previous simple cholecystectomy. Serious problems soon after surgery can include bile leakage into the abdomen, infections, and liver failure.
Material and Methods: From the report of Hospital Based Cancer registry (HBCR) of CNCI information regarding all cancer cases were collected and analyzed to find the proportion of cancer in gall bladder cases. Patients for this study was selected from the patients who undergone radical cholecystectomy for gall bladder carcinoma. Morbidity and mortality of the patient were observed within 30 days of procedure.
Results: Proportion gall bladder cancer cases for male and female was 3.7% and 8.94% respectively and overall proportion observed was 6.28%. The incidence of wound infection was higher in diabetics than non diabetics in patients undergoing CRS (15.4 vs. 11.0%, P < 0.001) and patients undergoing GS (5.3 vs. 3.1%, P < 0.001). Bile leakage is common with patients undergone common bile duct resection. Among 6 patients underwent CBD resection, 4 patients had <50ml bile leakage post operatively. Out of 30 patients, one hypertensive patient developed acute myocardial infacrtion.10 % patient had suffered major bleeding and given 3units of blood. The mean number of post-operative blood transfusion of the patients was 1.83±0.59 units with range 1-3 units.
Conclusion: Proportion gall bladder cancer observed was 6.28%. As radical cholecystectomy is a major procedure, we encountered few post operative complications like bleeding, septicemia wound infection, bile leak etc.
3. Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II, Alonso de Ruiz P, Aristi Urista G, Nervi F. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. 2001 Nov-Dec;51(6):349-64. [PubMed]
4. Serra I, Calvo A, Báez S, Yamamoto M, Endoh K, Aranda W. Risk factors for gallbladder cancer. An international collaborative case-control study. Cancer. 1996 Oct 1;78(7):1515-7.
5. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006 Apr 1;118(7):1591-602.
6. Welton JC, Marr JS, Friedman SM. Association between hepatobiliary cancer and typhoid carrier state. Lancet. 1979 Apr 14;1(8120):791-4.
7. Matsukura N, Yokomuro S, Yamada S, Tajiri T, Sundo T, Hadama T, Kamiya S, Naito Z, Fox JG. Association between Helicobacter bilis in bile and biliary tract malignancies: H. bilis in bile from Japanese and Thai patients with benign and malignant diseases in the biliary tract. Jpn J Cancer Res. 2002 Jul;93(7):842-7. [PubMed]
8. Chijiiwa K, Noshiro H, Nakano K, Okido M, Sugitani A, Yamaguchi K, Tanaka M. Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using western and Japanese classification systems. World J Surg. 2000 Oct;24(10):1271-6; discussion 1277.
9. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, FormanD,Bray,F.GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBaseNo.11[Internet].Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 07/05/2016.
10. Kresl JJ, Schild SE, Henning GT, Gunderson LL, Donohue J, Pitot H, Haddock MG, Nagorney D. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma. Int J Radiat Oncol Biol Phys. 2002 Jan 1;52(1):167-75.
11. Makela JT, Kairaluoma MI. Superselective intra-arterial chemotherapy with mitomycin for gallbladder cancer.Br J Surg 1993;80:912–915.
12. Albores-Saavedra J, Henson DE. Atlas of Tumor Pathology, 2nd Series, Fascicle 22: Tumors of the Gallbladder and Extrahepatic Bile Ducts. Washington DC: Armed Forces Institute of Pathology; 1986.
13. Roa I, Araya JC, Villaseca M, et al. Preneoplastic lesions and gallbladder cancer: an estimate of the period required for progression. Gastroenterology 1996;111:232–236.
14. Itoi T,Watanabe H, Ajioka Y,et al. APC, K-ras codon 12 mutations and p53 gene expression in carcinoma and adenoma of the gallbladder suggest two genetic pathways in gallbladder carcinogenesis. Pathol Int 1996;46:333–340.
15. Dutta U, Nagi B, Garg PK, Sinha SK, Singh K, Tandon RK. Patients with gallstones develop gallbladder cancer at an earlier age. Eur J Cancer Prev. 2005 Aug;14(4):381-5.
16. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, FormanD,Bray,F.GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBaseNo.11[Internet].Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 07/05/2016.