Presentation of gallbladder carcinoma and its surgical management

Abstract

Objective:- To study the mode of presentation, age and sex distribution, socio-economic status and evaluation of various surgical methods adopted for treatment of localized and advanced gallbladder carcinoma. Design:- It was a prospective type of study. Place and duration of study: This study was conducted in the Department of Surgery Nishtar Hospital, Multan from January 2004 to June 2005. Patients and methods: Twenty five patients of all ages and both sex were taken from all surgical units. On the basis of history, examination and laboratory investigations they were suspected of having gallbladder cancer. All the patients were operated and were divided into three groups on the basis of operative findings and stage of disease. Results:- There were 4 males and 21 female with a male to female ratio of 1:5. Presenting feature in decreasing order of frequency were; pain in right hypochondrium in 88%, nausea and vomiting in 60%, weight loss in 40%, jaundice in 28%, anorexia in 28%, mass in right hypochondriu m in 24%, pruritis in 20%, fever in 12% and ascites in 4% patients. Preoperative diagnosis of carcinoma of gallbladder was possible in 12 (48%) patients with the help of ultrasound and CT scan but all were of advanced age of disease. Gall stone were the most important etiological factor in 20 (80%) patients, obesity was found in 7 (28%) and chronic typhoid infection in 2 (8%) patients. All patients were operated. Simple cholecystecytomy was done in 4 patients of stage I and II. Extended cholecystectomy done in 6 patients of stage III. Laparotomy and biopsy of the mass and/or palliative surgery for drainage of bile was done in 15 cases of stage IV and V disease. Adenocarcinoma was the most common histological type found in 22 (88%) cases. Conclusion:- Gallstone are the most important etiological factor in gall bladder carcinoma.