A study on incidence of Incidental Gallbladder Carcinoma in simple Cholecystectomy Specimen by histopathology, management and follow-up

Prem Kumar, E (2015) A study on incidence of Incidental Gallbladder Carcinoma in simple Cholecystectomy Specimen by histopathology, management and follow-up. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Cholecystectomy is the most common major abdominal procedure performed worldwide. Carcinoma of gallbladder is the 5th most common cancer of digestive tract and the most common malignancy of the biliary tract.The clinical manifestations of gall bladder carcinoma are generally indistinguishable from those associated with cholecystitis or cholelithiasis. Around 90% of GB (Gall bladder) carcinoma have accompanying stone.Stones and chronic inflammation are the risk factors for carcinoma of gallbladder. Most of the cases of GB carcinoma are diagnosed during or after surgery performed for stones or benign biliary diseases. Despite advancements in various diagnostic procedures, preoperative diagnosis of early GB carcinoma is very difficult to diagnose. Advanced stage of the disease because of delayed diagnosis leads to its poor prognosis. AIMS AND OBJECTIVES: The purpose of the present study is to find the incidence of Incidental Gallbladder Carcinoma in simple Cholecystectomy Specimen by histopathology, management and follow-up. study design: prospective observational study. materials: 100 patients. study & follow-up period : One year. Inclusion criteria: All patients with undergoing simple cholecystectomy for gall stone and benign biliary disease. Exclusion criteria: Patients with pre diagnosed Gallbladder malignancy, Gallbladder mass, Empyema Gallbladder and Gallstones associated with obstructive jaundice were excluded. MATERIALS AND METHODS: Patient presenting with right hypochondrial pain, jaundice, dyspepsia will be taken detailed history, clinical examination and necessary investigations including blood complete picture, liver function tests and ultrasound abdomen. Patients who are diagnosed as having gall stones and other benign biliary disease who require simple cholecystectomy are subjected to open/laparoscopic cholecystectomy and the gallbladder specimens will be sent for histopathological study. Patients with positive histology for carcinoma will be called up and managed depending upon the stage of disease and followed up for one year. Data will be collected and analyzed through SPSS version 16. DISCUSSION: Gallbladder Carcinoma (GBC) is the most common malignancy of the biliary tract and the sixth most common malignancy of the gastrointestinal tract worldwide. It is an aggressive and a late symptomatic disease and most of the patients are treated at advanced stages. The prognosis is usually dismal and the 5 year survival rates have been reported to be less than 5% for the more advanced stages. The countries with a high incidence of gallbladder cancer include Chile, Poland, India and Japan. A very high incidence of this cancer has been reported among women in northern India (21.5/100,000) and among female Native American Indians (14.5/1000,000). The early-stage carcinoma is typically diagnosed incidentally because of the inflammatory symptoms which are related to the coexistent cholelithiasis or cholecystitis. CONCLUSION: • incidence of Incidental GBC found in my study is 2%. • Incidental GBC is becoming more common due to the wide spread use of LC procedures being carried out for benign GB disease • However, this may be decreasing due to use of ultrasound scanning for upper abdominal symptoms suggestive of GB disease • Open or L C is adequate treatment for pTis and pT1 • Given the high rate of residual disease , therefore re-resection still the only curative treatment ,and should be strongly considered for pT2 and pT3, but no CBD resection • Although the type of hepatic resection does not appear to affect the outcome, it is essential to achieve tumour-free surgical margins. • The prognosis is usually dismal and the 5 year survival rates have been reported to be less than 5% for the more advanced stages.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Incidental Gallbladder Carcinoma ; simple Cholecystectomy Specimen ; histopathology ; management ; follow-up study
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 22 Oct 2017 03:22
Last Modified: 22 Oct 2017 03:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/3804

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