Treatment approach for gallbladder cancer in a public hospital in Nicaragua

Abstract

Presenter: Sergio Lopez Torrez MD, MSc | Roberto Calderon University Hospital Background: Gallbladder cancer (GBC) is the most common malignancy of the biliary tract, however, is a relatively rare occurrence with a poor prognosis (overall 5-year survival is 50% for stage I cancers and 3% for stage IV cancers). Risk factors include age, female sex, gallbladder polyps greater than 1 cm cholelithiasis and chronic inflammation. Imaging techniques such as computerized tomography and ultrasound scan can aid with the diagnosis. Patients with GBC diagnosed after cholecystectomy for suspected benign disease represent more than half of new cases. Incidentally discovered GBCs have improved survival, because they are often diagnosed at an earlier stage, the oncologic resection include radical cholecystectomy with liver resection plus lymphadenectomy and in selective case biliary tract resection with reconstruction. Unfortunately, most of the cases is presented in advanced stage for palliative care and some cases include chemotherapy. The objective of this study is to describe the therapeutic approach in patients with Gallbladder cancer in the public hospital Dr Roberto Calderon (HDRC) Managua, Nicaragua. Methods: Descriptive cross sectional study; 85 patients were included, those with a clinical, histological or radiological diagnosis of gallbladder cancer in HDRCG from 2013 to 2019. Continuous variables are presented as mean ± standard deviation (SD) or as median (25th percentile, 75th percentile). Results: Our study revealed that the female sex was predominant with 79% of the cases, the average age was 58.6 years, 67% of our patients came from urban areas, 15.2% of the cases had undergone a previous cholecystectomy, 48 patients (56%) was presented in advanced stage, for received palliative care or no treatment. At the time of diagnosis 90% of patients presented with right upper quadrant pain and 34% were jaundiced. Regarding imaging studies, only 63% had a CT scan. The majority of patients had one single lesion, however, 9.4% of cases had multiple lesions. The diagnosis was confirmed through biopsy in 67% , being the adenocarcinoma the histology in 98% of the cases. With regards to treatment modalities, 43.5% of the cases underwent surgery, these surgeries included; conventional cholecystectomy 18% (16 patients) , convention cholecystectomy + hepaticojejunostomy 5,8% (5), segment IV-V hepatectomy + lymphadenectomy 13% (11), segment IV and V hepatectomy + lymphadenectomy + hepaticojejunostomy 5.8% (5); 21 % of the patients received systemic chemotherapy and 34% received palliative care with percutaneous biliary drenage or T Tube drenage. The morbidity related to the surgery was 15%. And finally 9.4% of patients died in the hospital, all of them in advanced stage. Research limitations: The follow up in the study was short, the average follow up in months was mean 5.05 months, but nevertheless in the surgery group the maximum survival was 38 months. Conclusion: Gallbladder cancer is relative common in our institution, unfortunately the most of the case is diagnosed in advanced stage. The surgery is the most important treatment with positive outcomes short and long term.