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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 74-77

Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study


Department of Surgery, Medical College, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

Date of Submission15-Mar-2019
Date of Acceptance24-Mar-2019
Date of Web Publication30-Jul-2019

Correspondence Address:
Dr. Mohammad Bukhetan Alharbi
Department of Surgery, Medical College, Imam Mohammad Ibn Saud Islamic University, Zip Code 11543, PO Box 5701, Riyadh,
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijas.ijas_4_19

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  Abstract 


Background: Gallbladder cancer, well despite the fact that it is rare, it is the most common malignancy of the biliary tree. However, preoperative abilities to diagnose the disease are still limited. Thus, variability in prevalence globally is obvious.
Materials and Methods: Cross-sectional study was done to assess the prevalence of surgically removed gallbladder from February 2007 to August 2018 which was collected from 1085 patients in a community hospital in Gurayat Hospital, situated along the northern border.
Results: The prevalence of gallbladder cancer was 0.2%. The mean age was 38.4 years. 96 (8.9%) patients were with acute cholecystitis, 107 (9.9%) with acute on chronic cholecystitis, 10 (0.9%) with gangrenous cholecystitis, and 872 (80.3%) patients with chronic cholecystitis.
Conclusion: The prevalence of gallbladder cancer which is discovered at cholecystectomy is rare in Saudi Arabia.

Keywords: Adenocarcinoma, gallbladder adenocarcinoma, gallbladder cancer


How to cite this article:
Alharbi MB. Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study. Imam J Appl Sci 2019;4:74-7

How to cite this URL:
Alharbi MB. Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study. Imam J Appl Sci [serial online] 2019 [cited 2019 Aug 24];4:74-7. Available from: http://www.e-ijas.org/text.asp?2019/4/2/74/263663




  Introduction Top


Cholecystectomy procedure is quite common worldwide, with almost 1 million procedures being done annually in the US.[1] Thus, the current condition of a higher rate of cholecystectomy with better ultrasound techniques led to more earlier detection of gallbladder cancer.[2]

Gallbladder cancer is the most common malignancy of the biliary tree; epidemic regions such as Chile, Peru, and India are likely to have environmental factors besides genetic predisposition. Gallbladder cancer risk increases with age and female gender.[3],[4]

The main risk factor for gallbladder cancer is the presence of long-standing gallstone, which has multiple gallbladder mucosal epithelial injuries and repair,[5],[6] patients with gallstone disease have a higher risk of the development of gallbladder cancer up to 57 times, based on multiple cohort studies.[7],[8] Chronic infection was found in almost 15% of cases of malignancy worldwide,[9] and on the other side, all malignancies, in general, are related with chronic inflammation regardless of the infection either absent or present.[10]

 Salmonella More Details typhi is another important factor in endemic areas,[11] other pathological conditions such as primary sclerosing cholangitis and bacterial infections have some relation between chronic gallbladder cancer and gallstone disease, as they share the chronic inflammation component.[3]

Gallstone itself is not the main cause of damage to the epithelial layer of gallbladder, but the action of its nature as a foreign body does this sequence for the development to gallbladder cancer. Hence, this is a classical example of inflammation-associated carcinoma.[12],[13] Furthermore, gallstones larger than 2 cm have a higher chance of developing into gallbladder cancer.[14]

Association between aflatoxin and gallbladder cancer have been reported; it was found that 20% of cases of gallbladder cancer in China have been exposed to aflatoxin, based on serum levels of alpha toxin B1-lysine.[15]

Gallbladder polyps usually found in almost 12% of gallbladders removed surgically, they will be detected in almost 7% of ultrasound done for gallbladder.[16],[17],[18] However, despite that only 0.6% of those polyps are malignant,[19] only polyps ≥10 mm have a higher chance of malignancy approaching 65%.[18] Furthermore, some gallbladder polyps require to follow-up for many years, 7 years is the cutoff where the potentials for malignancy in the follow-up should be clear, which make 10-year follow-up is reasonable for such group of patients.[20],[21]

Gallbladder cancer is not considered to follow adenoma-carcinoma sequence; however, it is believed to follow dysplasia-carcinoma sequence.[14],[22] The fundus of the gallbladder is the most common site for malignancy, and the neck is the least common site. Furthermore, the most common malignancy is adenocarcinoma.[14] The 5-year survival rate is poor, for advanced type (T3, 4) it is 10%.[16],[23]

Other risk factors are obesity,[24] multiparty,[25] smoking,[26] and specific metal exposure with environmental pollution.[27]

The annual detection of new cases in the US is 8500 patients, with the prevalence of 2/100,000 patient each year.[28],[29],[30]

The overall mean survival rate for patients with advanced gallbladder cancer is 6 months, with a 5-year survival rate of 5%.[31] Well, usually, the diagnosis is late secondary to vague presenting symptoms and lack of serosa.[6],[32],[33] However, most of the gallbladder cancers are adenocarcinoma (80%), originating from fundus (60%), body (30%), and neck (10%). Furthermore, genetic predisposition and presence of cholecystitis are other important features.[4],[34]


  Materials and Methods Top


This a cross-sectional study to assess the prevalence of gallbladder cancer data of surgically removed gallbladder between the years February 2007 and August 2018, which were collected from 1085 patients from the Community Hospital in the Northern Border of Saudi Arabia. Gross examination and microscopic examination were done, and all histopathology reports have been collected and included in the study. Further, cases without or missing report have been excluded from this study, such as cases xanthogranulomatous cholecystitis, polyps, cholesterolosis, and age below 18 years old.

The distribution of gallbladder disease was calculated based on the age; the youngest age was 13 years old and the oldest was 88 years old. Patients with acute cholecystitis were 96 patients, in which 107 patients were with acute on chronic cholecystitis, and 871 patients with chronic cholecystitis. Furthermore, the median age was 35 years, with 865 females and 220 males.

The prevalence of gallbladder cancer was 0.2% (2/1085). The mean age was 38.4 years. 96 (8.9%) patients were with acute cholecystitis, 107 (9.9%) with acute on chronic cholecystitis, 10 (0.9%) with gangrenous cholecystitis, and 872 (80.3%) patients with chronic cholecystitis.


  Discussion Top


The delayed presentation is quite common in gallbladder cancer, due to the nonspecific presentation, further, around 20% of patients will be diagnosed intraoperatively for features of cholecystitis, abdominal pain, nausea and vomiting, anorexia, and weight loss which is the most common complaints.[35] Furthermore, constitutional symptoms, ascites, and a palpable mass are all indicative of advanced disease and poor prognosis.[36]

The most frequent radiological test which is utilized in similar conditions such as ultrasound, which is usually mixed with chronic cholecystitis, especially in early stages of cancer indicated that the sensitivity to detect gallbladder cancer preoperatively approach 44%.[37]

However, risk factors for such disease are still limited but have association with gallstone, high fat and carbohydrate diet, multiple pregnancies, as well as hormonal replacement therapy which will make higher risk of the gallbladder cancer.[38],[39]

Gallstone is the most famous risk factor, also the highest mortality from gallbladder cancer is in Chile, and has the highest prevalence of cholelithiasis.[40],[41] The risk of gallbladder cancer with gallstones is more common up to 5 times than those with a calculous cholecystitis,[42] also women in some studies are not affected by this fact.[43] Further, large size gallstone and long period of symptoms are associated with a higher chance to develop gallbladder cancer.[44] However, from the other side, the presence of stone to develop gallbladder cancer is not a must.[45]

The duration of stone presence is highly important to the development of gallbladder cancer.[46] Chronic inflammation of gallbladder mucosa may develop malignancy trough atypia to dysplasia to carcinoma sequence.[47] Furthermore, P53 mutation may have a role in this sequence of events.[48]

Porcelain gallbladder is considered a risk for gallbladder cancer with 5% chance. Moreover, it seems that focal mucosal calcification (7%) is posing a greater risk over diffuse transmural calcification (porcelain gallbladder).[49]

Current therapies for gallbladder cancer have not shown a dramatic change in the overall survival. However, the current clinical trials focus on symptom control or recurrent disease.[50]


  Conclusion Top


Gallbladder cancer prevalence in Saudi Arabia is rare; thus, pathological assessment of the sample with proper staging plays an important role in further definitive surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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