Incidence, clinical presentation, management and outcome of gall bladder cancer as seen at Kenyatta National Hospital (1988-2000)
This was a retrospective study of patients with histologically confirmed diagnosis of gallbladder cancer seen and managed at Kenyatta National Hospital during the period 1 sl January 1988 to 31 sl December 2000. A total of 24 patients were seen at Kenyatta National Hospital over the thirteen year period. with an average of 1.9 cases per year. Gallbladder cancer accounted for 0.09% of all malignancies and 0.003% of all admissions during the study period. The incidence of gallbladder cancer in cholecystectomy specimens at KNH was 1.97%. A total of 203 cholecystectomies were performed for benign gallbladder diseases during the study period, with an average of 15.6 operations per annum. 30.5% of the patients undergoing cholecystectomy for benign gallbladder disease were above 51.0 years of age, with a female to male ratio of 3:1. The peak age incidence for patients with cancer was 51 - 55 years, with a mean age of 52.0 years of age (range 27 - 82 years). 62.5% of the patients were above 51.0 years of age. There was a female predominance, with a female to male ratio of 2: 1. Most of the patients presented with advanced disease. The commonest presenting symptom was abdominal pain, followed by jaundice, pruritus, nausea, vomiting, anorexia, weight loss, and abdominal distension cmass. 87.5% of the patients had symptoms for less than one year. The most common physical findings were abdominal tenderness, jaundice, hepatomegaly, pallor, palpable gallbladder, fever and ascites. Abdominal ultrasound was performed in 83.3% of the patients. Other radiological investigations done incluae abdominal CT scans, plain abdominal x-rays, barium meal studies, oesophagogastro-duodenoscopy, and percutaneous transhepatic cholanqioqraphy. The laboratory findings were non-specific and not diagnostic of gallbladder cancer. The frequent abnormalities detected include anaemia, leucocytosis, hypoalbuminaemia and elevated serum alkaline phosphatase. The commonest histological type of gallbladder cancer seen was adenocarcinoma of varying degrees of differentiation (87.5%). Gallstones were present in 41.7% of the patients with gallbladder carcinoma. The correct pre-operative diagnosis of gallbladder cancer was made in only 8.3% of the patients. In the majority of patients (75%), the diagnosis was established at operation with no preoperative suspicion of the diagnosis. Cholelithiasis, chronic cholecystitis, pancreatic carcinoma, bile duct cancer and liver cancer were considered the most likely preoperative diagnoses. In 16.7% of the patients the diagnosis was first made by the pathologist after cholecystectomy for presumed benign disease. One third of the patients with gallbladder cancer had exploratory laparotomy and biopsy only. Cholecystectomy was carried out in 7 patients. One patient had partial cholecystectomy performed. No radical surgery was undertaken. 33.3% of the patients underwent palliative biliary-enteric or gastrointestinal bypass procedures. Only 8.3% of the patients received adjuvant post-operative radiation therapy, while one patient was given postoperative chemotheraphy. The duration of follow-up was short; with 41.7% of patients on follow-up for less than two months. One quarter of the patients with 8<.:;;uiadder cancer died within the first month postoperatively, whereas only 4.2% of the patients were still alive and on follow-up one year after the diagnosis of cancer.