Carcinoma Gall Bladder & Periampullary Carcinoma In A Tertiary Medical College In India- An Epidemiological Audit.

Background- Being a teaching hospital attached with a superspecialty school of Digestive and Liver disease a lot of gall bladder patients presents to us for treatment. This audit was done with the aim to understand the present epidemiological situation of carcinoma gall bladder in eastern India. Methods- All patients with carcinoma gall bladder who first presented in the year 2015 and 2016 were included in the study. Data was collected from the Departmental patient specific charts that are maintained in Departmental MR section. Results - there were 126 patients who were included in the audit. The average age of the patients were 52 years with 95% patients being in the age group of 40yrs 6 months and 63 years. 90(>75%) of these patients were Female while only 36 males. Contrary to the popular perception at the time of presentation only 10 patients out of 126 were obese. 60% of our patients (76) were smokers but only 11 had the habit of using chewable tobacco. Nearly half of them (65 out of 126) had either a prior or concurrent history of gallbladder stones. Concurrent history includes radiological evidence in inoperable carcinoma gall bladder. None of them were known to be typhoid carriers. In this group of patients 19 had periampullay carcinoma, one had concurrent GIST in stomach. The rest were proven carcinoma gall bladder with histologically / cytologically adenocarcinoma. 89 patients were non metastatic while 37 were metastatic. 31 of them were to liver, 3 to lung, one to lung and brain and 3 to distal paraaortic nodes. Most of the patients 95 out of 126, presented with pain abdomen. A fourth of them were clinically icteric and 52 out of 126 had raised bilirubin on biochemistry. Performace status was generally not good and there were no ECOG 0 or 1 patients. 38% of the patients had a perfornce status of ECOG 3. The rest (barring one whose ECOG was 4) had a PS of ECOG-2. Of the 89 non metastatic patients 19 were deemed surgically inoperable. 11 underwent Whipples procedure, to underwent surgical procedure which included liver bed resection, four were medically unfit for surgery. The rest of the patients underwent a cholecystectomy for carcinoma gall bladder of which nearly half (23) underwent lap cholecystectomy. 3 patients were found to be inoperable on table and the procedure had been abandoned. Out of the 37 metastatic patients, 10 were unfit for any therapy and was offered best supportive care. Rest were started on palliative chemotherapy with either GEMOX (21) or single agent Gemcitabine (6). 22 patients were kept on follow up post operatively while others had residual disease for which further chemotherapy was advised. OF these 22 patients with a median follow up time of 7 months, 6 had recurrence and had to be started on chemotherapy. Those offered post operative chemotherapy, the average number of cycles were 4.5 with 60% of them completing 6 cycles of chemotherapy. Conclusion- Cacinoma gall bladder is one of the common yet understated malignancies in India especially in females. The presentation is late with advanced disease. Treatment options are limited due to poor performance status and advanced disease status. [ABSTRACT FROM AUTHOR]