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Incidence and outcomes of gallbladder cancer treatment in a rural patient population
Electronic Poster Abstracts Results: From September 2013 to July 2015, 19 patients underwent for intent of curative resection. 13 out 19 were resectable. The median age was 65.6 years old. 27% were male and 73% were women. Pain was present on 58,8%. Jaundice was present on 78%. Cholecystits on 15,6%, cholelithiasis on 29,41%. Liver metastases were found on 34 patients at the moment of the diagnosis. Radical cholecystectomy was the procedure on 13 patients. Postoperative care in ICU was 0, 73 days. Morbidity 30e60 days was 2% and post operative mortality rate was 0%. Adenocarcinoma was the most frequent pathology. Analysis: Gallbladder cancer is a complex pathology not well studied in Colombia. The experience after 24 months reported 51 cases and only 19 underwent for surgery and only 13 were resectable Multidisciplinary team was the key to have acceptable morbidity and mortality. Conclusions: Gallbladder cancer needs more attention on Colombia’s public Health. Our small serie is significant on terms of the number of cases in a short period of time.
EP03B-008 “INCIDENTALLY DETECTED GALLBLADDER POLYPS: IS IT MALIGNANT?”, RETROSPECTIVE SINGLE INSTITUTION STUDY OF 108 PATIENTS A. Bavikatte1, A. Batwal1 and P. Dhar2 1 Department of Gastrointestinal and Transplant Surgery, and 2Amrita Institute of Medical Sciences, India Purpose: To determine the natural history of gallbladder (GB) polyps less than 10 mm incidentally detected at ultrasonography (US) and to propose management guidelines for these lesions. Method: A database search for “polyp” in all US examinations of the GB between January 1, 2008, and December 31, 2014 at a single institution was performed. All subsequent US reports were reviewed to determine changes in GB polyp size. The electronic medical record was searched to obtain clinical and pathologic follow-up. Results: GB Polyps were identified in 108 patients (Male e 81%, Females e 19%) with Median age e 50.9 years. Majority of polyps were detected during comprehensive health check up or during ultrasound abdomen evaluation for pain abdomen. The mean size of the polyps were 4.7 ± 2.15 mm (range of 1 mm to 15 mm). On follow up USG at 3 months, Polyp was of same size in 43% of the patients, it showed complete resolution in 32%, and in 12% the size of polyp had reduced. Only 10% had increase in size. Out of 956 cholecystectomies done, 20 (1.67%) were for GB Polyps (17-abdominal pain, 3-family history of GB cancer). Out of 20 that were operated, only 8 GB specimens (37%) had polyps on histopathology and remaining had stones. None of them showed any evidence of dysplasia or neoplasia.Ultrasound abdomen had a low sensitivity (39%). Conclusions: The risk of GB malignancy resulting from incidentally detected polyps is extremely low. Incidentally detected GB polyps measuring 10 mm less may require no
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additional follow-up, although further studies are required to substantiate.
EP03B-009 INCIDENCE AND OUTCOMES OF GALLBLADDER CANCER TREATMENT IN A RURAL PATIENT POPULATION D. McDonald1, R. Hall2, T. Ramos1, J. Lee1 and I. W. Browder1 1 Surgery, East Tennessee State University, and 2Transplant, University of Texas College of Medicine, United States Introduction: Gallbladder carcinoma is a rare but aggressive malignancy with increasing prevalence. This analysis reviews thirty-five cases of gallbladder cancer in five years and outcomes within this unusually large number of patients referred to three tertiary hospitals within a rural community (estimated total population 250,000). Methods: A retrospective review of patients with pathologically identified gallbladder carcinoma, treated within 2006e 2012 was preformed. Of the 14 male and 21 female patients, the average age and ASA class were 67.88 11.88 years old and 3.17 0.61. Overall survival was 25.02 25.17 months. Mean survival decreased with increasing stage. Results: There was no statistically significant association between tumor differentiation and patient survival. Pathology containing lymphovascular invasion had significantly decreased survival. There was no statistically significant increase in survival rate for those undergoing radical resection/ re-resection for the entire cohort; however, for patients with Stage II and Stage III disease that underwent radical resection there was a statistically significant increase in survival. Of note, administration of chemotherapy did not confer an overall survival benefit for patients as a whole. Patients who received radiation therapy did not have an increased overall survival rate. Treatment by a hepato-pancreato-biliary surgeon conferred a statistically significant increase in survival. Conclusion: An increased incidence of gallbladder carcinoma within our rural patient population far exceeds current SEER data (thirty-five patients in five years). Stage II and Stage III gallbladder carcinoma receive the largest benefit from R0 resections. The survival benefit of chemotherapy administration in our stage IV gallbladder carcinoma patients deserves further investigation.
EP03B-010 WHICH IS THE BEST IMAGING METHOD TO DIAGNOSE GALLBLADDER CARCINOMA IN PATIENTS WITH ASYMPTOMATIC GALLBLADDER POLYPS? L. P. Schneider1, C. Y. Morioka2,3,4, R. Chojniak4,5, L. C. Serigiolle4,5, H. M. P. Gomes4, N. W. Zancope4, C. C. Huang6,7 and J. Pinhata Otoch2 1 Universidade de Taubate, 2Department of Surgery, University of Sao Paulo, 3Hospital Sirio Libanes, 4University Nove de Julho, 5Imaging, Hospital AC Camargo, 6 Advantage Health, and 7Advantage Business Consulting, Brazil
EP03B-008 “INCIDENTALLY DETECTED GALLBLADDER POLYPS: IS IT MALIGNANT?”, RETROSPECTIVE SINGLE INSTITUTION STUDY OF 108 PATIENTS A. Bavikatte1, A. Batwal1 and P. Dhar2 1 Department of Gastrointestinal and Transplant Surgery, and 2Amrita Institute of Medical Sciences, India Purpose: To determine the natural history of gallbladder (GB) polyps less than 10 mm incidentally detected at ultrasonography (US) and to propose management guidelines for these lesions. Method: A database search for “polyp” in all US examinations of the GB between January 1, 2008, and December 31, 2014 at a single institution was performed. All subsequent US reports were reviewed to determine changes in GB polyp size. The electronic medical record was searched to obtain clinical and pathologic follow-up. Results: GB Polyps were identified in 108 patients (Male e 81%, Females e 19%) with Median age e 50.9 years. Majority of polyps were detected during comprehensive health check up or during ultrasound abdomen evaluation for pain abdomen. The mean size of the polyps were 4.7 ± 2.15 mm (range of 1 mm to 15 mm). On follow up USG at 3 months, Polyp was of same size in 43% of the patients, it showed complete resolution in 32%, and in 12% the size of polyp had reduced. Only 10% had increase in size. Out of 956 cholecystectomies done, 20 (1.67%) were for GB Polyps (17-abdominal pain, 3-family history of GB cancer). Out of 20 that were operated, only 8 GB specimens (37%) had polyps on histopathology and remaining had stones. None of them showed any evidence of dysplasia or neoplasia.Ultrasound abdomen had a low sensitivity (39%). Conclusions: The risk of GB malignancy resulting from incidentally detected polyps is extremely low. Incidentally detected GB polyps measuring 10 mm less may require no
HPB 2016, 18 (S1), e385ee601
e475
additional follow-up, although further studies are required to substantiate.
EP03B-009 INCIDENCE AND OUTCOMES OF GALLBLADDER CANCER TREATMENT IN A RURAL PATIENT POPULATION D. McDonald1, R. Hall2, T. Ramos1, J. Lee1 and I. W. Browder1 1 Surgery, East Tennessee State University, and 2Transplant, University of Texas College of Medicine, United States Introduction: Gallbladder carcinoma is a rare but aggressive malignancy with increasing prevalence. This analysis reviews thirty-five cases of gallbladder cancer in five years and outcomes within this unusually large number of patients referred to three tertiary hospitals within a rural community (estimated total population 250,000). Methods: A retrospective review of patients with pathologically identified gallbladder carcinoma, treated within 2006e 2012 was preformed. Of the 14 male and 21 female patients, the average age and ASA class were 67.88 11.88 years old and 3.17 0.61. Overall survival was 25.02 25.17 months. Mean survival decreased with increasing stage. Results: There was no statistically significant association between tumor differentiation and patient survival. Pathology containing lymphovascular invasion had significantly decreased survival. There was no statistically significant increase in survival rate for those undergoing radical resection/ re-resection for the entire cohort; however, for patients with Stage II and Stage III disease that underwent radical resection there was a statistically significant increase in survival. Of note, administration of chemotherapy did not confer an overall survival benefit for patients as a whole. Patients who received radiation therapy did not have an increased overall survival rate. Treatment by a hepato-pancreato-biliary surgeon conferred a statistically significant increase in survival. Conclusion: An increased incidence of gallbladder carcinoma within our rural patient population far exceeds current SEER data (thirty-five patients in five years). Stage II and Stage III gallbladder carcinoma receive the largest benefit from R0 resections. The survival benefit of chemotherapy administration in our stage IV gallbladder carcinoma patients deserves further investigation.
EP03B-010 WHICH IS THE BEST IMAGING METHOD TO DIAGNOSE GALLBLADDER CARCINOMA IN PATIENTS WITH ASYMPTOMATIC GALLBLADDER POLYPS? L. P. Schneider1, C. Y. Morioka2,3,4, R. Chojniak4,5, L. C. Serigiolle4,5, H. M. P. Gomes4, N. W. Zancope4, C. C. Huang6,7 and J. Pinhata Otoch2 1 Universidade de Taubate, 2Department of Surgery, University of Sao Paulo, 3Hospital Sirio Libanes, 4University Nove de Julho, 5Imaging, Hospital AC Camargo, 6 Advantage Health, and 7Advantage Business Consulting, Brazil