Extended Cholecystectomy with Reconstruction of Right Hepatic Artery for Carcinoma Gallbladder: A Case Report

Abstract

The role of vascular reconstruction in surgical resection of advanced carcinoma gall bladder remains unclear, with scarce available literature. Evaluating the benefit of curable resection against the risk of increased postoperative morbidity remains a fine balancing act. Here, we report a case of a 45-year-old male who presented with obstructive jaundice and significant weight loss over 3 months. CECT showed bilateral IHBRD with patent primary confluence and an enhancing polypoidal mass in the proximal CBD of size 11 x 12 mm, in continuity with asymmetric mural thickening of GB neck. Fat planes with vascular structures were seen to be preserved. Possibilities of carcinoma gall bladder or cholangiocarcinoma were considered. Patient underwent ERCP and stenting of the right ductal system for resolution of jaundice. Extended cholecystectomy with extrahepatic bile duct resection and Roux-En-Y hepaticojejunostomy was performed. Intraoperatively, right hepatic artery was found involved with tumor; therefore, a 1 cm segment of the artery was resected and end to end anastomosis was done. Finally, a diagnosis of adenocarcinoma of gallbladder with positive liver resection margin (R1 resection) was made on histopathological examination. The resected right hepatic artery margins, however, were found to be free of tumor. Post-operative course remained uneventful, with no vascular complications. Patient received adjuvant chemoradiotherapy. He remains symptom free at 10 months post-surgery. Our case highlights that right hepatic artery reconstruction can be done in advanced carcinoma gallbladder with low surgical risk and that it remains a viable option for achieving curative resection.