Skip to main content

Advertisement

SpringerLink
Log in

Audit of Management of Gallbladder Cancer in a Nigerian Tertiary Health Facility

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Background

Gallbladder cancer is a rare malignancy with a variable incidence worldwide. It ranks number eight among all gastrointestinal cancer seen in Nigeria. It is associated with high mortality and morbidity because it is usually diagnosed very late. Adequate surgical resection is the only modality with hope of cure. This requires advanced surgical skills which is quite rare in most developing countries like Nigeria. In this current work, we audit the management and outcome of gallbladder cancer in our hospital, highlighting peculiarity associated with our setting.

Patients and Method

Consecutive patients managed as cases of gallbladder cancer at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1990 and December 2010 were studied retrospectively. Patient demographics, disease and treatment-related variables, and outcomes were analyzed by SPSS version 16.0.

Results

Thirty-one cases of gallbladder cancer were diagnosed over the 21-year period, and this accounts for about 0.3% of all cancer cases seen in our hospital. The median age of this patient cohort was 58 years (range 28 to 79 years). Seventeen (54.8%) patients were age below 60 while 14 (45.2%) were age 60 and above. Twenty-seven patients (87.1%) were female and four (12.9%) were male, with a male to female ratio approximately 1:7. Over 80% of the patients presented with a triad of upper abdominal pain, weight loss, and jaundice. Majority (67.7%) of the patients were diagnosed intraoperatively. Only four patients underwent complete resection as they had radical cholecystectomy including regional lymph node dissection and wedge resection of the gallbladder fossa of the liver. The stages of the resected patients were T3 in three patients and T2 in one. Overall 1- and 5-year survival rates for our entire patient cohort were 32% and 10%, respectively.

Conclusion

In conclusion, this study showed that preoperative diagnosis of gallbladder cancer could be challenging in our environment. A triad of upper abdominal pain, jaundice, and weight loss with judicious use of available radiological modality will increase the chances of making the preoperative diagnosis of the cancer. It also showed that good outcome can be obtained when radical surgery is offered to these few patients within the limitation of resources in few patients with resectable tumor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Reid KM, Medina AR, Donohue JH. Diagnosis and surgical management of gallbladder cancer: a review. J Gastrointest Surg. 2007;11:671–81.

    Article  PubMed  Google Scholar 

  2. Hueman M, Vollmer C, Pawlik T. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 2009;16:2101–15.

    Article  PubMed  Google Scholar 

  3. Cobourn N, Cleary S, Tan J, et al. Surgery for gallbladder cancer: a population-based analysis. J Am Coll Surg. 2008;207:371–82.

    Article  Google Scholar 

  4. Butte JM, Matsuo K, Gönen M, D’Angelica MI, et al. Gallbladder cancer: differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. J Am Coll Surg. 2011;212:50–61.

    Article  PubMed  Google Scholar 

  5. Randi G, Malvezzi M, Levi F, et al. Epidemiology of biliary tract cancers: An update. Ann Oncol. 2009;20:146–59.

    Article  PubMed  CAS  Google Scholar 

  6. Andia M, Gederlini A, Ferreccio C. Gallbladder cancer: trend and risk distribution in Chile. Rev Med Chile. 2006;134:565–74.

    Google Scholar 

  7. Kayahara M, Nagajawa T. Recent trends of gallbladder cancer in Japan. Cancer. 2007;100:572–80.

    Article  Google Scholar 

  8. Mayo CS, Shore AD, Nathan H, Edil B, et al. National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis. J Gastrointest Surg. 2010;14:1578–91.

    Article  PubMed  Google Scholar 

  9. Gourgiotis S, Kocher HM, Solaini L, Yarollahi A. Gallbladder cancer. Am J Surg. 2008;196:252–64.

    Article  PubMed  Google Scholar 

  10. Akute OO, Ayantunde AA, Obajimi MO. A review of gall bladder carcinoma in Ibadan. Niger Postgrad Med J. 2003;10(4):228–30.

    PubMed  CAS  Google Scholar 

  11. Chianakwana GU, Okafor PI, Anyanwu SN. Carcinoma of the gallbladder at the Nnamdi Azikiwe University Teaching Hospital—a 5-year retrospective study. Niger J Clin Pract. 2005;8(1):10–3.

    PubMed  CAS  Google Scholar 

  12. Obonna GC, Njoku T, Okoro E, Osime U. Gallbladder carcinoma not associated with cholelithiasis: report of 2 cases. Niger J Surg Sci. 2007;17:113–5.

    Google Scholar 

  13. Abdulkareem FB, Faduyile FA, Daramola AO, Rotimi OA, et al. Malignant gastrointestinal tumours in south western Nigeria: a histopathologic analysis of 713 cases. WAJM. 2009;28(3):173–6.

    CAS  Google Scholar 

  14. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006;118:1591–602.

    Article  PubMed  CAS  Google Scholar 

  15. Wistuba I, Gazdar A. Gallbladder cancer: lessons from a rare tumour. Nat Rev Cancer. 2004;4:695–706.

    Article  PubMed  CAS  Google Scholar 

  16. Hsing AW, Bai Y, Andreotti G, et al. Family history of gallstones and the risk of biliary tract cancer and gallstones: a population-based study in Shanghai, China. Int J Cancer. 2007;121:832–8.

    Article  PubMed  CAS  Google Scholar 

  17. D’Angelica M, Moore Dalal K, DeMatteo R, et al. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009;16:806–16.

    Article  PubMed  Google Scholar 

  18. Reddy S, Marroquin C, Kuo P, et al. Extended hepatic resection for gallbladder cancer. Am J Surg. 2007;194:355–61.

    Article  PubMed  Google Scholar 

  19. Araida T, Higuchi R, Hamano M, et al. Hepatic resection in 485R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey. A multicenter study. J Hepatobiliary Pancreat Surg. 2009;16:204–15.

    Article  PubMed  Google Scholar 

  20. Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol. 2003;4:167–76.

    Article  PubMed  Google Scholar 

  21. Strom BL, Soloway RD, Rios-Dalenz JL, et al. Risk factors for gallbladder cancer: an international collaborative case–control study. Cancer. 1995;76:1747–56.

    Article  PubMed  CAS  Google Scholar 

  22. Lazcano-Ponce EC, Miquel JF, Munoz N, Herrero R, Ferrecio C, Wistuba II, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. 2001;51:349–64.

    Article  PubMed  CAS  Google Scholar 

  23. Randi G, Franceschi S, Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006;118:1591–602.

    Article  PubMed  CAS  Google Scholar 

  24. Kiran RP, Pokala N, Dudrick SJ. Incidence pattern and survival for gallbladder cancer over three decades—an analysis of 10301 patients. Ann Surg Oncol. 2006;14(2):827–32.

    Article  PubMed  Google Scholar 

  25. Dutta U, Nagi B, Garg PK, et al. Patients with gallstones develop gallbladder cancer at an earlier age. Eur J Cancer Prev. 2005;14:381–5.

    Article  PubMed  CAS  Google Scholar 

  26. Kayahara M, Nagakawa T, Nakagawara H, et al. Prognostic factors for gallbladder cancer in Japan. Ann Surg. 2008;248:807–14.

    Article  PubMed  Google Scholar 

  27. Goldin RD, Roa JC. Gallbladder cancer: a morphological and molecular update. Histopathology. 2009;55:218–29.

    Article  PubMed  Google Scholar 

  28. Nakayama K, Konno M, Kanzaki A, et al. Allelotype analysis of gallbladder carcinoma associated with anomalous junction of pancreaticobiliary duct. Cancer Lett. 2001;166:135–41.

    Article  PubMed  CAS  Google Scholar 

  29. Yokoyama N, Hitomi J, Watanabe H, et al. Mutations of p53 in gallbladder carcinomas in high-incidence areas of Japan and Chile. Cancer Epidemiol Biomarkers Prev. 1998;7:297–301.

    PubMed  CAS  Google Scholar 

  30. Caygill CP, Hill MJ, Braddick M, Sharp JC. Cancer mortality in chronic typhoid and paratyphoid carriers. Lancet. 1994;343:83–4.

    Article  PubMed  CAS  Google Scholar 

  31. Dutta U, Garg PK, Kumar R, Tandon RK. Typhoid carriers among patients with gallstones are at increased risk for carcinoma of the gallbladder. Am J Gastroenterol. 2000;95:784–7.

    Article  PubMed  CAS  Google Scholar 

  32. Shukla VK, Singh H, Pandey M, Upadhyay SK, Nath G. Carcinoma of the gallbladder—is it a sequel of typhoid? Dig Dis Sci. 2000;45:900–3.

    Article  PubMed  CAS  Google Scholar 

  33. Lam CM, Yuen AW, Wai AC, et al. Gallbladder cancer presenting with acute cholecystitis: a population-based study. Surg Endosc. 2005;19:697–701.

    Article  PubMed  CAS  Google Scholar 

  34. Hawkins WG, DeMatteo RP, MD, Jarnagin WR, Ben-Porat L, MS, Blumgart LH, Fong Y. Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol. 11(3):310–5.

  35. Agarwal AK, Mandal S, Singh S, Bhojwani R, Sakhuja P, Uppal R. Biliary obstruction in gall bladder cancer is not sine qua non of inoperability. Ann Surg Oncol. 2006;14(10):2831–7.

    Article  Google Scholar 

  36. Chijiiwa K, Sumiyoshi K, Nakayama F. Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg. 1991;15:332–7.

    Article  Google Scholar 

  37. Hederstrom E, Forsberg L. Ultrasonography in carcinoma of the gallbladder: diagnostic difficulties and pitfalls. Acta Radiol. 1987;28:715–21.

    Article  PubMed  CAS  Google Scholar 

  38. Kumar A, Aggarwal S. Carcinoma of the gallbladder: CT finding in 50 cases. Abdom Imaging. 1994;19:304–8.

    Article  PubMed  CAS  Google Scholar 

  39. Serra I, Calvo A, Baez S, Yamamoto M, Endoh K, Aranda W. Risk factors for gallbladder cancer. An international collaborative case control study. Cancer. 1996;78:1515–7.

    Article  PubMed  CAS  Google Scholar 

  40. Miller G, Jarnagin WR. Gallbladder carcinoma. EJSO. 2008;34:306e312.

    Article  Google Scholar 

  41. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA. 1983;250:2323–6.

    Article  PubMed  CAS  Google Scholar 

  42. Puhalla H, Laengle F. Gallbladder cancer—only surgery is curative. Eur Surg. 2006;38:100–6.

    Article  Google Scholar 

  43. Tewari M, Kumar V, Mishra RR, Kumar M, Shukla HS. Is there a role for cholecystectomy in gallbladder carcinoma discovered to be unresectable for cure at laparotomy? World J Surg. 2008;32:2683–7.

    Article  PubMed  Google Scholar 

  44. Xiao WD, Peng CH, Zhou GW, Zhou GW, Wu WD, et al. Surgical treatment for Nevin stage IV and V gallbladder carcinoma: report of 70 cases. Hepatobiliary Pancreat Dis Int. 2005;4:589–92.

    PubMed  Google Scholar 

  45. Blalock A. A statistical study of 888 cases of biliary tract disease. Johns Hopkins Hosp Bull. 1924;35:391–409.

    Google Scholar 

  46. Kondo S, Nimura Y, Kamiya J, et al. Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg. 2002;387:222.

    Article  PubMed  Google Scholar 

  47. Kaneoka Y, Yamaguchi A, Isogai M, et al. Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg. 2003;27:260–5.

    Article  PubMed  Google Scholar 

  48. Iyer RV, Gibbs J, Kuvshinoff B, Fakih M, Kepner J, Soehnlein N, et al. A phase II study of gemcitabine and capecitabine in advanced cholangiocarcinoma and carcinoma of the gallbladder: a single-institution prospective study. Ann Surg Oncol. 2007;14(11):3202–9.

    Article  PubMed  Google Scholar 

  49. Malik IA, Aziz Z, Zaidi SH, Sethuraman G. Gemcitabine and cisplatin is a highly effective combination chemotherapy in patients with advanced cancer of the gallbladder. Am J Clin Oncol. 2003;26(2):174–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, College of Health Science, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

    O. I. Alatise, O. O. Lawal, A. O. Adisa, O. A. Arowolo, E. A. Agbakwuru & A. R. K. Adesunkanmi

  2. Department of Radiology, College of Health Science, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

    O. O. Ayoola

  3. Department of Morbid Anatomy, College of Health Science, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

    G. O. Omoniyi-Esan & O. O. Olaofe

  4. Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Osun State, Nigeria

    O. I. Alatise

Authors
  1. O. I. Alatise
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. O. Lawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. O. Adisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. A. Arowolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. O. O. Ayoola
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. A. Agbakwuru
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. R. K. Adesunkanmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. O. Omoniyi-Esan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. O. O. Olaofe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. I. Alatise.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alatise, O.I., Lawal, O.O., Adisa, A.O. et al. Audit of Management of Gallbladder Cancer in a Nigerian Tertiary Health Facility. J Gastrointest Canc 43, 472–480 (2012). https://doi.org/10.1007/s12029-011-9335-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-011-9335-4

Keywords

Search

Navigation