Global Journal of Surgery
ISSN (Print): 2379-8742 ISSN (Online): 2379-8750 Website: http://www.sciepub.com/journal/js Editor-in-chief: Baki Topal
Open Access
Journal Browser
Go
Global Journal of Surgery. 2017, 5(1), 17-19
DOI: 10.12691/js-5-1-6
Open AccessArticle

Gallbladder Cancer in Sudan: A Two-centre Study

Walid Elhaj Abdelrahim1, , Kamal Elzaki Elsiddig1, Mohamed Elhassan Akoad2, Mohamed Abbas1 and Eltahir AG Khalil3

1Department of Surgery, Faculty of Medicine, University of Khartoum, Sudan

2Department of Transplantation, Lahey Clinic, Tufts University, USA

3Department of Clinical Pathology & Immunology, Institute of Endemic Diseases, University of Khartoum, Sudan

Pub. Date: December 18, 2017

Cite this paper:
Walid Elhaj Abdelrahim, Kamal Elzaki Elsiddig, Mohamed Elhassan Akoad, Mohamed Abbas and Eltahir AG Khalil. Gallbladder Cancer in Sudan: A Two-centre Study. Global Journal of Surgery. 2017; 5(1):17-19. doi: 10.12691/js-5-1-6

Abstract

Poor prognosis of gallbladder cancer (GBC) is due to delayed presentation. Female gender and gallstones are important risk factors. Surgical resection offers significant improvement in 5 year actuarial survival. In Sudan, proper imaging modalities and professional multi-disciplinary teams are available but, inter-disciplinary management protocols haven't been established. This paper aims to delineate the patterns of presentation, possible risk factors and the natural history of GBC to guide management practices in resource-limited settings. The records of 106 patients from two tertiary referral centres were examined. Inclusion criteria included: radiological features of gallbladder mass in addition to one of the following: liver metastasis, porta hepatis lymphadenopathy and/or ascites. The majority of patients were females (70.5%) with a mean age of 64.27¡À11.39 years with median duration of symptoms of 3 months. The main presenting symptoms were: loss of weight (39.2%), abdominal swelling (35.8%), obstructive jaundice (31.1%) and vomiting (17.6%). Cholelithiasis as detected by ultrasound/CT/MRI was reported in most cases (75.4%). Liver metastasis, biliary dilatation and lymphadenopathy were seen in 67.2%, 40.3% and 39% respectively. Open simple cholecystectomy was performed in a quarter of the patients (24.5%), none had re-resection after postoperative diagnosis of GBC. No significant 3 and 6 months survival benefits were observed in the simple cholecystectomy group compared to those who didn¡¯t (p=0.8 and 0.2 respectively). More than fifty per cent (51.1%) of patients received chemotherapy, with no 3 and 6 months survival benefits. The main causes of death were obstructive jaundice complicated by cholangitis and gastric outlet obstruction in 69.5% and 30.5% of patients respectively. The overall survival of CBC patients was 4.96¡À12.5 months. Most patients presented late, the majority had unrespectable disease, very short duration of symptoms and poor survival. Patients with advanced disease should have holistic palliative approach via a multi-discilpinary team together with systemic chemotherapy.

Keywords:
gall bladder cancer simple cholecystectomy chemotherapy cholelithiasis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Lazcano-Ponce E.C., Miquel J.F., Munoz N., Herrero R., Ferrecio C., Wistuba, II, Alonso de Ruiz P., Aristi Urista G., Nervi F. "Epidemiology and molecular pathology of gallbladder cancer". CA: A Cancer Journal for Clinicians 2001; 51:349-64.
 
[2]  Randi G., Franceschi S., La Vecchia C. "Gallbladder cancer worldwide: geographical distribution and risk factors". International Journal of Cancer 2006; 118:1591.
 
[3]  Randi G., Malvezzi M., Levi F., Ferlay J., Negri E., Franceschi S., La Vecchia C. "Epidemiology of biliary tract cancers: an update". Annals of Oncology, 2009; 20:146.
 
[4]  Serra I., Diehl A.K. "Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma". Journal of Gastrointestinal Surgery 2002; 6: 272-3.
 
[5]  Bartlett D.L., Fong Y., Fortner J.G., Brennan M.F., Blumgart L.H. "Long-term results after resection for gallbladder cancer. Implications for staging and management". Annals of Surgery 1996; 224: 639-46.
 
[6]  Shirai Y., Yoshida K., Tsukada K., Muto T. "Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy". Annals of Surgery 1992; 215:326-31.
 
[7]  Yamaguchi K., Tsuneyoshi M. "Subclinical gallbladder carcinoma". American Journal of Surgery 1992; 163:382-6.
 
[8]  Donohue J.H., Nagorney D.M., Grant C.S., Tsushima K., Ilstrup D.M., Adson M.A. "Carcinoma of the gallbladder. Does radical resection improve outcome?". Archives of Surgery 1990; 125: 237-41.
 
[9]  Chijiiwa K., Tanaka M. "Carcinoma of the gallbladder: an appraisal of surgical resection". Surgery 1994; 115: 751-6.
 
[10]  Shirai Y., Yoshida K., Tsukada K., Muto T., Watanabe H. "Radical surgery for gallbladder carcinoma. Long-term results". Annals of Surgery 1992; 216: 565-8.
 
[11]  Chianale J., del Pino G., Nervi F. "Increasing gall-bladder cancer mortality rate during the last decade in Chile, a high-risk area". International Journal of Cancer 1990; 46:1131-3.
 
[12]  Wood R., Fraser L.A., Brewster D.H., Garden O.J. "Epidemiology of gallbladder cancer and trends in cholecystectomy rates in Scotland, 1968-1998". European Journal of Cancer 2003; 39: 2080-6.
 
[13]  Diehl A.K., Beral V. "Cholecystectomy and changing mortality from gallbladder cancer". Lancet 1981; 2: 187-9.
 
[14]  Terzi C., Sokmen S., Seckin S., Albayrak L., Ugurlu M. "Polypoid lesions of the gallblad.der: report of 100 cases with special reference to operative indications". Surgery 2000; 127: 622-7.
 
[15]  Kumaran V., Gulati S., Paul B., Pande K., Sahni P., Chattopadhyay K. "The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder". European Radiology 2002; 12: 1993-9.
 
[16]  The Southern Surgeons Club. "A prospective analysis of 1518 laparoscopic cholecystectomies". New England Journal of Medicine 1991; 324: 1073-8.
 
[17]  Goetze T.O., Paolucci V. "Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German registry". Annals of Surgery 2008; 247: 104-8. 2008.
 
[18]  Wakai T., Shirai Y., Yokoyama N., Nagakura S., Watanabe H., Hatakeyama K. "Early gallbladder carcinoma does not warrant radical resection". British Journal of Surgery 2001; 88: 675-8.
 
[19]  Fong Y., Jarnagin W., Blumgart L.H. "Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior non-curative intervention". Annals of Surgery 2000; 232: 557-69.
 
[20]  Sharma A., Dwary A.D., Mohanti B.K., Deo S.V., Pal S., Sreenivas V., et al. Best supportive care compared with chemotherapy for unresectable gall bladder cancer: a randomized controlled study. Journal of Clinical Oncology 2010; 28: 4581-6. 2010.