Totally laparoscopic radical resection for incidental gallbladder cancer

Abstract

Background: Incidental gallbladder cancer is a common condition in high risk countries with an 3% incidence of all laparoscopic cholecystectomies. We present our approach for radical cholecystectomy in incidental gallbladder cancer. Methods: A 53 year-old female with no comorbidities underwent a laparoscopic cholecystectomy for symptomatic gallstone disease. Postoperative histhopathology study showed infiltrative adenocarcinoma to subserosal layer (pT2). A staging CT scan and CA19-9 were normal. We offered to her a totally laparoscopic radical resection (lymphadenectomy plus liver resection). the video shows a Kocher maneuver and an intercavo-aortic lymphadenectomy for contemporary frozen histopathology study. Five intercavo-aortic lymphatic nodes was negative. The hepatic pedicle lymphadenectomy was performed retrieving all tissue around the main bile duct, portal vein, celiac trunk, common hepatic artery and right and left hepatic arteries. A IVB-V liver resection using bipolar and ultrasonic scalpel to complete the radical resection was done. A Jackson Pratts drain was left at the surgical site. Blood loss was 50ml and Pringle maneuver lasted 20 minutes. Results: She had an uneventful postoperative evolution and was discharged home on postoperative day 2. The histopathology study showed a 140g liver piece and 18 lymph node without evidence of residual disease. Conclusion: Totally laparoscopic radical resection for incidental gallbladder cancer is feasible with oncological principles