Indian Council of Medical Research consensus document for the management of gall bladder cancer

Abstract

EXECUTIVE SUMMARY The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.All postcholecystectomy gallbladder specimens should be opened and examined carefully by the operating surgeon and be sent for histopathological examination.All “incidental” gall bladder cancers (GBCs) picked up on histopathological examination should have an expert opinion.Evaluation of a patient with early GBC should include essential tests: A computed tomography (CT) scan (multi-detector or helical) of the abdomen and pelvis for staging with a CT chest or chest X-ray, and complete blood counts, renal and liver function tests. magnetic resonance imaging/positron emission tomography (PET)-CT are not recommended for all patients.For early stage disease (up to Stage IVA), surgery is recommended. The need for adjuvant treatment would be guided by the histopathological analysis of the resected specimen.Patients with Stage IVB/metastatic disease must be assessed for palliative e.g. endoscopic or radiological intervention, chemotherapy versus best supportive care on an individual basis. These patients do not require extensive workup outside of a clinical trial setting.There is an urgent need for multicenter trials from India covering various aspects of epidemiology (viz., identification of population at high-risk, organized follow-up), clinical management (viz., bile spill during surgery, excision of all port sites, adjuvant/neoadjuvant therapy) and basic research (viz., what causes GBC).

Treatment of advanced Gall bladder cancer in the real world—can continuation chemotherapy improve outcomes?

“…Patients in our cohort showed an overall CBR comparable to those shown with GO in the study by Andre et al (50.7% vs. 57%) and better than the GBC cohort in the same study (43.4%). There is no direct comparison between GC and GO as first line therapy; the outcomes in this study may reflect the predominantly GO treated nature of the study cohort (12,13). The median EFS and OS in this study were 4.53 and 7.65 months, respectively.…”

“…being amongst them (11). The Indian Council of Medical Research (ICMR) consensus document for the management of GBC was an initial step in forming region specific guidelines , but there continues to be an unmet need in terms of cost effective as well as investigational strategies to improve outcomes in this group of cancers (12).…”

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…As data are sparse and few studies address incidental gallbladder cancer in isolation, papers were included when relevant data would have impact on management, such as studies on overall gallbladder cancer management. Thus, the identified studies included were 12 systematic reviews with or without meta‐analysis, seven consensus reports and guidelines, 15 multi‐institutional series, and seven national series/audits or registries. References of the identified articles were further searched for additional studies or reports of interest.…”

Spectrum of Lesions of Gall BladderExperience of Five Years at Tertiary Care Hospital

“…Gallbladder carcinoma (GBC) is a rare condition and as per ICMR report on consensus on management of GBC, the incidence is reported to be 7/100,000. [2] It is commonly diagnosed as an incidental histological finding following cholecystectomy for gallstone disease thus worsening the prognosis. Thus early and accurate histopathological diagnosis of gall bladder lesions may improvise the patient management and prognosis.…”