Cholecystectomy and IVB-V hepatic segmentectomy with complete lymphadenectomy in a T1b gallbladder carcinoma. A video case report

Abstract

Objective: Gallbladder carcinoma (GBC) is a rare disease, often diagnosed incidentally after a routine cholecystectomy. At the earliest stage T1a, cholecystectomy alone is curative in 90–100% cases. However, T1b carcinomas have been the focus of several publications, as weather extended resection could increase survival rates, with adequate morbidity. Most experts agree that en-bloc central hepatic resection should be done, in addition to lymph node dissection and resection of the porta hepatis and along the hepatoduodenal ligament, although there are no standards established as to the minimum number of lymph nodes examined. Methods: We report the case of a 67 years old woman, referred from another center with the diagnosis of GBC T1b after a routine cholecystectomy. Open IVb and V hepatic segmentectomy with lymphadenectomy of periaortic, pericava and hepatoduodenal ligament's nodes was done at our center. Results: We expose a detailed, well-structured video in which we evidence this procedure, with clear anatomic dissection. No complications were reported after surgery, and the patient continues alive with follow up studies up to the moment. Histopathological result of the lymphadenectomy showed no neoplastic infiltration. Conclusion: We believe radical R0 surgery is the only treatment capable of increasing GBC survival rates, especially when diagnosed at early stages.