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Incidental CaGB in Operated Cases of Gallstone Disease
Table 8: Symptoms comparison in CaGB vs chronic cholecystitis patients 1 month in surgery outpatient department (OPD) and later in
(N = 200) oncology OPD.
Incidental Chronic cholecystitis Total One patient with dysplasia bordering to adeno CaGB in situ
CaGB (n = 5) (n = 195) (n = 200) was followed up after 1 month for 3 months and then 3 monthly.
Chief complaints No. % No. % No. % Subsequent radiological studies were normal.
Upper abdominal 4 80 149 76.02 153 76.5
pain
Nausea 2 40 75 38.46 79 39.5 dIscussIon
Vomiting 1 20 34 17.43 36 18 Inapparent (also called occult or incidental) GBC is defined as GBC
Fever 1 20 6 3 8 4 unrecognized before or at operation and detected for the first time
Upper abdominal 0 0 0 0 0 0 on HPE of the gallbladder, which has been removed for presumed
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mass gallstone disease.
In our study, among the Incidental CaGB patients, minimum
Weight loss 0 0 8 4 8 4 age was 6 years; maximum age was 78 years, and mean age was
Anorexia 2 40 17 8.7 19 9.5 43.46 years. This finding is in accordance with previous studies.
Jaundice 1 20 4 2 5 2.5 Shukla et al. reported mean age of the CaGB patients to be 50 years
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(range 40–60 years.), the mean age of 1,728 patients from 29 series,
Table 9: Statistical tests for symptoms in CaGB vs chronic cholecystitis reported upon since 1960, was 65.2 years with incidence of CaGB of
patients
0.1, 1.5, 8.9, 19.6, 37.0, and 32.0% in third, fourth, fifth, sixth, seventh,
Parameter p value Test Comment and eighth decades, respectively. 4
Upper 0.72 Chi-square with Not significant Among 200 chronic cholecystitis patients, 30% are male and
abdominal pain Yate’s correction 70% are female. This could be because of the fact that cholecystitis
Nausea 0.69 Do Do is most common in female. Thus, in a hospital-based study, women
Vomiting 0.65 Do Do patients form a majority.
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Fever 0.42 Do Do Piehler and Crichlow showed that “Carcinoma of the
Anorexia 0.11 Do Do gallbladder is predominantly a disease of elderly females of 2,998
Jaundice 0.27 Do Do patients from 51 series reported over last 20 years, there were 2,292
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females (75%) and 706 males (25%), a female to male ratio of 3.2:1.
• Among incidental CaGB patients, 20% had fever. Among chronic In the study by IARC under SEARCH program, gallbladder cancer
cholecystitis patients, 3% had fever. was found to be commonest among women (56%) with cancer of
• Among incidental CaGB patients, 0% had mass, 100% had no the ampulla of the Vater coming second with 30%”.
mass. Among chronic cholecystitis patients, 0% had mass and According to our study, CaGB is common in female population
100% had no mass. because chronic cholecystitis is common in female population.
• Among incidental CaGB patients, 0% had weight loss, 100% Among 200 patients, 66.5% patients were housewives, 20%
had no weight loss, and 4% of chronic cholecystitis patients had were doing desk job. This could be explained by the Indian
weight loss, 96% had no weight loss. socioeconomic status and literacy rate.
• Forty percent of incidental CaGB patients had anorexia, 8.7% of Among 200 patients, 68.5% are from rural area and 31.5% are
chronic cholecystitis patients had anorexia. from urban area indicating geographical distribution of cases in
• Among incidental CaGB patients, 20% had jaundice. Among population.
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chronic cholecystitis patients, 2% had jaundice and 98% were Shukla et al. reported an incidence of 4.4% of all malignancies
normal. and 0.03% of total hospital admissions from Varanasi, India. Chao
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• Rest of the clinical features, investigations and intraoperative and Greager reported an incidence of 2.5/100,000 population
findings also resemble with chronic cholecystitis. and found CaGB in 1–3% of cholecystectomy specimens. In
• It was also noted that among the incidental CaGB patients, four our study, the incidence of incidental CaGB is 2.5%. Table 10
patients had laparoscopic cholecystectomy in which there are depicting comparison of incidence rate of incidental CaGB by
more chances of biliary spillage. Thus, possibility of the very various authors.
early disease becoming a disseminated disease. Clinical features of patients in this study were as follows.
• Table 9 shows statistical tests for symptoms in CaGB vs chronic Among 200 patients, 76.5% patients have upper abdominal pain.
cholecystitis patients. In this population, 39.5% had nausea, 18% patient had vomiting,
fever was present in only 4% of patients, 0% patient had abdominal
Follow-up mass, 4% patients had weight loss, 9.5% had anorexia, and 2.5%
• One-hundred and ninety-five patients with histopathological patients had clinical jaundice. In comparison, data regarding
examination (HPE) report symptoms of chronic cholecystitis the presentation of CaGB are presented in Table 11 depicting
were followed up for a period of 1 week postcholecystectomy. comparison of clinical symptoms of GBC by various authors.
• Two patients with poorly differentiated adeno CaGB (pT3NxMx) Pain was present in 47–97% of patients. This is comparable
and poorly differentiated adeno CaGB (pT2NxMx) lost to follow to the data (76.5%) in our study. Similarly, anorexia, weight loss,
up. nausea, and vomiting were comparable in this study, and jaundice
• Two patients with well-differentiated adeno CaGB (pT3NxMx) and is a feature of advanced CaGB. This shows that there are no clinical
moderately differentiated adeno CaGB (pT3NxMx) underwent features that would be suggestive of CaGB in a patient who presents
radical cholecystectomy and followed up subsequently for with symptoms of chronic cholecystitis (Table 11).

180 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)