Carcinoma Gall bladder: An overview from the Kashmir valley, Tertiary care experience.
Abstract
Abstract:
Background: Gallbladder (GB) cancer, though generally considered rare, is the most common malignancy of the biliary tract, accounting for 80%−95% of biliary tract cancers. Gall bladder cancer (GBC) is the most common biliary tract malignancy in India having an age standardized incidence rate of 1.8 per 100,000 population. Northern India has one of the highest reported incidence of gallbladder cancer (GBC) in the world. The incidence of GBC has a specific geographic and ethnic variation. In Kashmir which is ethnically and geographically distinct from rest of India, GB cancer ranks among top 10 cancers. Aim:The study aimed at analysing demography, clinical presentation and operative outcomes of GBC patients in the Kashmir valley. Material & Methods: A retrospective analysis of incidentally detected GBC patients ( IDCAGB) and Primary Gb Mass patients was performed to analyze the demographic and clinicopathological profile of presentation and treatment outcome. After initial radiological evaluation for operability, all the patients underwent surgical exploration. Extended cholecystectomy with hepatoduodenal clearance was done in all patients If found resectable. A total of 52 patients of carcinoma gall bladder were enrolled in this study. Results: In this study females were more common than males (male: female ratio=1:5). The mean age at diagnosis was 56±5.4 years. 51.92% of patients had GB mass while 48.07% patients presented with Incidentally detected gall bladder cancer (IDGBCA). Extended cholecystectomy with hepatoduodenal clearance was done in all patients. Adenocarcinoma was the most common histological type cholelithiasis was as associated with 72% of patients. Forty-eight percent (48%) of the IDGBCA patients had stage-I disease in contrast 55% patients with primary GB mass had Stage III disease. In our study Mean operative time was 150±30 mins, with an average blood loss of 350±70ml, average number of nodes retrieved were 10± 2, and majority of patients were discharged on 7th day. There were no major postoperative complications. There was no operative or in hospital mortality. Conclusion: GBC is not an uncommon clinical entity in Kashmir. It is predominantly a dis-ease of females. Patients with CAGB should undergo extended cholecystectomy as morbidi-ty is low with zero mortality, with studies showing improved survival after R0 resection. CAGB should be approached with multidisciplinary approach and not with nihilism. With increased use of laparoscopic cholecystectomy, surgeons should evaluate any suspicious findings on USG.
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