6 year retrospective study of cholecystectomy and.pptx

6 years retrospective of cholecystectomy

1. 6 year retrospective study of cholecystectomy and gall bladder cancer in 7 th October Hospital Benghazi Dr. Ateia H. Elfitori prof . Said . O . Elsaiti Dr . H . R . Busrewill Prof. Abdalhadi Mousa

2. INTRODUCTION Malignant tumours of gallbladder are uncommon and are usually primary . Primary malignancy of gallbladder comprise 1- 3% of all malignancies . Adenocarcinoma is the most frequent , with other primary malignancies such as sarcoma and carcinoid much less common . The disease is seen is 1-2% of cholecystectomy specimens .

3. It was the cause of death in 2000 men and 3500 women in U.K between 1966-1970 . There is an increase in incidence with age , particularly in female patients . The peak age incidence is 70-75 years , with male to female ratio of 1:3 (10,12) Several studies have shown that the majority of the gallbladder cancer is associated with cholelithiasis (6,15) . We have undertaken this study to assess the prevalence of gallbladder cancer (GC) in patients subjected to cholecystectomy for cholelithiasis

4. MATERIALS AND METHODS The entire population of Benghazi ; the second large city in Libya ; is estimated to be about 675.000. We reviewed and analyzed the data available in our department in collaboration with the histopathology department regarding all reports in the histopathology department

5. Results 13 cases of cancer of gallbladder were discovered during a 6 year period among 1208 choleccystectomy performed . This gives a prevalence figure of 1.08% . The study shows that cholecystectomy was done more females than males with a ratio of 4:1 . In case of Gall bladder cancer , the ratio was 8:5 Adenocarcinoma was the commonest histopathological type .

6. Grades II and III of the disease were the commonest . 93% of cases of Gall bladder cancer were associated with gallbladder stone and only 7% were associated with obstructive jaundice .

7. Table one: Distribution of No. of choleccystectomies, sex &gallbladder cancer per year of study Date No M F Ca. Gall bladder 2000 136 26 110 5 2001 100 10 90 1 2002 125 31 94 1 2003 336 55 281 3 2004 227 56 171 1 2005 284 81 203 2 total 1208 259 949 13

8. Table two: Histological finding in patients with gallbladder carcinoma Histopathology finding No. of cases M F Adenocarcinoma 10 5 5 Papillary carcinoma 1 1 Sequamous carcinoma 1 1 Mucoid carcinoma 1 1 Total 13 5 8

9. Table three: Stages of gallbladder cancer :- Stage F M Total I 2 2 II 4 1 5 III 2 4 6 Total 8 5 13

10. Table four: Clinical finding in cases of gallbladder cancer :- Clinical finding No. of cases Jaundice 1 Palpable mass 4 No sign 8

11. Discussion :- The cancer of gallbladder is known to be high in some countries like Chili & Mexico(≈ 5%) . (4,5) . There is an established association between carcinoma of gallbladder and gall bladder stone formation but the causative role of gallbladder stone in the formation of carcinoma is not yet clear (2) . The estimated risk of developing cancer in patients with lithiasis of gallbladder is 1-3%(14)

12. The most common symptoms gallbladder carcinoma are pain , weight loss and jaundice with a frequency of 76% , 39% and 39% respectively (7,14) . A proportion of patients presents a clinical picture of acute cholecystitis manifested by fever , leukocytosis , localized pain and tenderness . Some patients present with a clinical picture of empyema yet others show more advanced signs of the disease , with a variety of symptoms such as anorexia weight loss , vomiting and jaundice (6,8,11) .

13. Serum alkaline phosphatase values are most often elevated in patients with gallbladder carcinoma , but they do not assist in the differential diagnosis between benign and malignant disease . Overall cholecystgraphy in 90% of cases does not opacify the gallbladder . Intravenous cholecystography is unsuccessful in 93% of patients (9,16) . However , endoscopic retrograde cholangiopancreatography may be diagnostic (9,13) . Angiography is not helpful in detecting early lesions , but it may help to demonstrate the extent of the disease (13,6) . Ultrasound and computed tomography are of limited value in the early stages(16) .

14. Pre-operative diagnosis can only be made in 5-18%of patients (3,12) . It is clear from the literature that gallbladder cancer with gross invasion of liver has poor prognosis . 50% of patients with Gall bladder cancer die within 3 months of diagnosis and less than 5% survive for one year (1,3) . This short study shows that gallbladder stone may act as an alarm bell for the diagnosis or even pre-emptive intervention for Gall bladder cancer However , other issues need to be raised such as the cost-effectiveness of such an approach if compared with a more conservative one .

15. Reference :- 1. Barsmuth H, Malte R (1979) . Carcinoma of the biliary tract N Eng1 J Med ; 302:704-706 . 2. Borden G, Bengstone L(1980) . Carcinoma of gallbladder in relation to Cholelithisis and to concept of prophylactic cholecystectomy Acta chir scand ; 500 : 15-18 . 3. Collier AN , carr D , Hemnigway A , Blugwert LH . (1984) Pepoperative diagnosis and its effect on the treatment of carcinoma of the gallbladder . Surg Gynecol Obeset ; 159: 465-470 . 4. Diehl AK (1980) ; Epidemiology of gallbladder cancer : National cancer Inst ; 60 : 1209-1214 . 5. Diehl AK (1980) ; Epidemiology of gallbladder cancer a synthesis of recent data . J National cancer ; 65 : 1209-1214 . 6. Hart J , Baruch M , Mordechai S . (1971) Choleithiasis in etology of gallbladder neoplasms . Lancet ; 1151-1153 .

16. 7. Henson DE , Albres Saavedra J, Corl D. (1992) Carcinoma of gallbladder Histological types , stage of disease , grade &survival rates Cancer 70: 1493-1494   8. Hughes-OD ; Haray-PN ;Williams-IM , Roberts ; Lewis-MH . (1997) . J R Col Surg Edind ; 42(4):280-2 . 9. Konnigsberg M , Wiener SN , Walzer A,(1997) Accuracy of sonography in the differential diagnosis of obstructive jaundice a comparioson with cholecystectomy . Radiology ; 133:157-165 . 10. Koo J , Wong J Cheng FCY , Ong GB. (1978) . Carcinoma of the gallbladder ; 147: 929-942 . 11. Muris IM , Morris DL . (1986) . Carcinoma gallbladder . Brit J Hos Med ; 36: 287-280 . 12. Nevin JE . Carcinoma of the gallbladder cancer. A synthesis of recent data . J Nat cancer 1980 ; 65:1209-1214 .

17. 13. Ogoshi K, Nima M . The diagnosis evaluation of ERCP in pancreatitis and biliary carcinoma . 14. Piecher JM .(1978) . primary carcinoma of gallbladder . Surg gynaecol obeset ; 147:929-942 . 15. Wilkson- DS (1995) : Carcinoma gallbladder Australia N Z J surgery ; 65(10): 724-7 . 16. Yeh Hc . (1975) . Ultrasonography and computed tomography of carcinoma of gallbladder . Radiology ; 133:167-173 .

18. THANKS