Original Contribution to Surgical Oncology: Developing an Integrated Staging and Treatment Pathway for Gallbladder Cancer in Nigeria

Gallbladder cancer (GBC) is an aggressive malignancy with a poor prognosis in Nigeria, where the absence of a national staging system, inconsistent surgical approach, and lack of adjuvant therapy access limit outcomes. No Nigeria-specific integrated staging and treatment pathway for GBC currently exists. This dissertation develops an original integrated staging and treatment pathway for GBC in Nigeria through a multiphase methodological design. Phase one comprised a systematic review of global GBC management guidelines; phase two was a retrospective multicenter cohort analysis of 120 GBC cases across five geopolitical zones from 2015 to 2023; and phase three involved a modified Delphi consensus process with 28 Nigerian surgical oncologists to validate the proposed pathway. The multicenter analysis revealed that only 18% of GBC cases were resected with curative intent, with T1b and T2 tumours achieving the best outcomes following radical cholecystectomy. Adjuvant gemcitabine-cisplatin was accessible to fewer than 10% of eligible patients. The Delphi process achieved consensus on a seven-step integrated pathway encompassing preoperative staging, operative strategy, margin assessment, nodal dissection extent, adjuvant therapy eligibility, and follow-up frequency. The pathway represents an original clinical algorithm for Nigerian GBC management and is recommended for adoption by the Nigerian Association of Surgical Oncology. Keywords: gallbladder cancer, surgical oncology, treatment pathway, Nigeria, Delphi consensus