Laparoscopic radical cholecystectomy for gallbladder cancer

A 50-year-old reformed smoker male from West Bengal was earlier admitted to a hospital nearby and was managed conservatively for mild acute biliary pancreatitis. He was advised to undergo laparoscopic cholecystectomy after a month. He presented to Apollo Main Hospital for a cholecystectomy. Ultrasound abdomen and Contrast enhanced CT showed sludge in the gallbladder with irregular enhancing wall thickening in the fundus and proximal body with no significant lymphadenopathy. His tumor markers were normal. In view of suspicion of malignancy, he underwent staging laparoscopy and laparoscopic cholecystectomy with a wedge of liver excised along with it. The Frozen section suggested malignancy. He underwent an extended lymphadenectomy laparoscopically. Post operative recovery was uneventful, and was discharged two days following surgery. Histopathology confirmed a margin-free, moderately differentiated adenocarcinoma pT3N0 with perineural invasion and was advised for adjuvant chemotherapy.

What features suggested malignancy in this patient?

Patient from the sub-Himalayan region and imaging features.

How to approach in such cases?

When imaging is suspicious but not confirming malignancy, a staging laparoscopy and wedge liver biopsy can be done and the patient sent for a frozen section. If it turns out positive, and lymphadenectomy can be completed.

Can the surgery be done laparoscopically?

In experienced hands, a radical cholecystectomy can be done laparoscopically safely. Lymphadenectomy and liver resection laparoscopically is technically demanding, but if done properly, survival is similar to open surgery. Early recovery is key to laparoscopy. If this was done by a conventional open approach-subcostal incision would increase morbidity and hospital stay.

Any precaution were taken to avoid port site metastasis?

GB was least handled thoroughout the procedure and retrieved through a pfannansteil incision using a wound protector.