title: Patterns of Presentation, Treatment, and Survival Rates of Gallbladder Cancer: a Prospective Study at a Tertiary Care Centre.
abstract: BACKGROUND
  India has high incidence of gallbladder carcinoma with regional variation in incidence, the highest in Northern India. This study examines the patterns of presentation, treatment strategies, and survival rate of all patients with gallbladder cancer (GBC) evaluated at our tertiary academic hospital over a period of 2 years.
  
  
  METHODS
  All patients presented to our institute with established tissue diagnosis of carcinoma gallbladder were accrued in our study over a time period of 2 years. Presentation, treatment modalities, and survival rates were analyzed.
  
  
  RESULTS
  One hundred six patients were included: 80 females and 26 males (F: M = 3:1). Median age was 60 years. Eighty patients (75%) had gallstones and 20 patients (21%) had typical history of chronic cholecystitis. The common symptom and sign at presentation were pain in the right upper abdomen (81%) and lump abdomen (49%), respectively. Overall resectability rate was 19.8% (21/106). Eighty-five patients were unresectable or metastatic and treated with palliative intent. Stagewise distribution at diagnosis was stage I (0%), stage II (4%), stage IIIA (10%), stage IIIB (8%), stage IVA (17%), and stage IVB (61%). Estimated 1-year survival for stages II, IIIA, IIIB, IVA, and IVB was 100, 76, 47.4, 26, and 10.6%, respectively. Significant difference in OS was observed among different stages of GBC (p value <0.001).
  
  
  CONCLUSIONS
  If proper investigations are done, radical surgery including multi-organ resection can be curative with acceptable morbidity and mortality. Stage at presentation and ability to perform curative resection are the most important prognostic factors predicting survival. Palliative chemotherapy should be considered for metastatic GBC.
authors.affiliation: Department Surgical Oncology, Army Hospital (Research & Referral), New Delhi, 110010, India. mlnsantosh@yahoo.co.in.
authors.forename: Santosh Kumar
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Department Surgical Oncology, Army Hospital (Research & Referral), New Delhi, 110010, India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Talwar
authors.affiliation: Department Surgical Oncology, Command Hospital (SC), Pune, 411040, India.
authors.forename: Narayanan
authors.initials: N
authors.lastname: Kannan
authors.affiliation: Department Surgical Oncology, Army Hospital (Research & Referral), New Delhi, 110010, India.
authors.forename: Arvind Kumar
authors.initials: AK
authors.lastname: Tyagi
authors.affiliation: Department Surgical Oncology, Army Hospital (Research & Referral), New Delhi, 110010, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Jaiswal
authors.affiliation: Department Surgical Oncology, Army Hospital (Research & Referral), New Delhi, 110010, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002763:Cholecystectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009367:Neoplasm Staging; D011446:Prospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers
keywords: Gallbladder cancer; Multi-organ resection; Palliative chemotherapy; Resectability rate