Incidental gallbladder cancer: Missing links in Pakistani population

Abstract

Aims: To determine frequency of incidental gallbladder cancer (IGBC) in Pakistani population, its demographic/histopathological features and type of surgical resections performed. Methods: This observational study was conducted at Combined Military Hospital (CMH)/Armed Forces Institute of Pathology (AFIP) Rawalpindi, Pakistan from July 2009 to July 2015. Clinical as well as pathological records of all patients who underwent laparoscopic cholecystectomy (LC) / open cholecystectomy (OC) were reviewed and data was obtained regarding IGBC and benign gallbladder pathology. Patients diagnosed Sajid Muhammad Tanveer1, Hussain Syed Mukarram2, Hashmi Shoaib Nayyar3, Mustafa Qurat Ul Ain4, Shaheen Neelofar5 Affiliations: 1MBBS, FCPS, Assistant Professor & Classified Surgical Specialist, Department of General and Laparoscopic surgery, Combined Military Hospital Rawalpindi, Punjab, Pakistan; 2MBBS, FCPS, Associate Professor & Head of Department, Department of General and Laparoscopic Surgery, Combined Military Hospital Rawalpindi, Punjab, Pakistan; 3MBBS, FCPS, FRCP, Professor & Head of Department, Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan; 4MBBS, Senior Registrar, Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan; 5MBBS, Senior Medical Officer, Department of General and Laparoscopic Surgery, Combined Military Hospital Rawalpindi, Punjab, Pakistan. Corresponding Author: Muhammad Tanveer Sajid, C/o Hafiz Ghulam Mustafa Ezzy traders Hakeem jee building Jinnah road Abbottabad, KPK, Pakistan, 22010; Email: doc_tanveersajid@hotmail.com Received: 02 April 2016 Accepted: 22 June 2016 Published: 23 February 2017 with cancer underwent staging investigations and were offered definitive surgery. Overall frequency and clinicopathological features of IGBC were studied. Results: One hundred sixtyfour patients out of 10,549 had IGBC (1.55%). Mean age of presentation in IGBC and benign gallbladder pathology patients was 59.23±12.17 and 45.73±13.11 years respectively (p-value <0.001). Cancer patients had significantly more comorbid (73.17% versus 39.43%, p-value <0.001) and larger stones (p-value <0.001). Histopathology revealed adenocarcinoma in 148 (90.24%), adenosquamous carcinoma in 08 (4.88%), undifferentiated in 04 (2.44%), squamous cell carcinoma in 02 (1.22%), sarcoma and melanoma in one patient each (0.61%). Most of the tumors were well differentiated (36.59%) and liver was most commonly infiltrated organ (52.44%). Thirty-four patients had stage I, 38 patients had stage II, 49 patients had stage III and 43 patients had stage IV cancer (20.73%, 23.17%, 29.88%, 26.22% respectively). Surgical resection included no further treatment in 31 patients as cholecystectomy proved adequate vis-à-vis stage, extended cholecystectomy in three patients (1.83%), radical cholecystectomy in 17 (10.37%), pancreaticoduodenectomy (Whipple) in 6 (3.66%), palliation/symptomatic management in 42 (25.61%) patients while 65 (39.63%) patients refused surgery. Adequate lymphadenectomy was performed only in 50 (30.49%) patients while 44 (26.83%) showed positive resection margins. Conclusion: IGBC must be kept in mind while performing cholecystectomy and every specimen should undergo routine histopathological examination. Radical surgery should be offered and may improve outcome in carefully selected cases.