Management and Outcome of Gallbladder Carcinoma with Obstructive Jaundice: a Retrospective Study from Eastern Nepal

Abstract

Gall bladder carcinoma (GBC) is an aggressive malignancy. The presence of jaundice indicates advanced-stage disease, and it is a relative contraindication to radical resection. However, recent studies have indicated that aggressive resection with curative intent is possible in selected group of patients, which may improve the survival. The aim is to evaluate the management and outcome of patients in GBC with obstructive jaundice. Retrospective analysis of a prospectively maintained database of patients of GBC with obstructive jaundice over a 3-year period was done. Data focused on incidence of jaundice, resectability, type of surgery, morbidity/mortality, and survival outcome. Out of 139 patients with GBC, 56 (40.3%) presented with jaundice. Among them, 13 patients with jaundice underwent surgery, as deemed resectable on preoperative staging work-up. The mean age of the cases was 51.4 years (range, 36–61); female, 10/13 (77%), mean preoperative serum bilirubin, 10.6 mg/dl; and mean CA 19-9, 17 ng/ml (range, 2.5–54). None of the patients required preoperative biliary drainage. Five patients underwent surgery with curative intent (extended cholecystectomy + bile duct excision-2; extended right hepatectomy + bile duct excision-1; hepatopancreatoduodenectomy-1; extended cholecystectomy + bile duct exploration for stone-1). The operative morbidity and mortality was seen in 60 and 20%, respectively. Histopathological examination confirmed stage III adenocarcinoma. All patient received adjuvant chemotherapy. The mean disease-free and overall survival was 23 and 30 months, respectively. Among the remaining eight patients, four patients had diffuse peritoneal metastases, requiring biopsy, while the other four underwent a palliative procedure (gastrojejunostomy, hepaticojejunostomy, and T-tube placement).Resection with curative intent in GBC with jaundice is feasible in selected group of patients with modest survival benefit.