Laparoscopic cholecystectomy done in a patient with cholelithiasis. Pathology repo shows adenocarcinoma with invasion of muscular layer. CT was normal. Fuher t/t is:
Correct Answer: Wedge hepatic resection with lymph node dissection
Description: Wedge hepatic resection with lymph node dissection The appropriate management for gallbladder cancer depends on the stage of cancer. Let's first see the TNM staging for gallbladder cancer. TNM staging of Gallbladder cancer Definition of TNM Primary tumor (T) TO No evidence of primary tumor Tis Carcinoma in situ T1 TI a Tlb Tumor invades lamina propria or muscle layer Tumor invades lamina propria Tumor invades muscle layer T2 Tumor invades perimuscular connective tissue; no extension beyond serosa or into liver T3 Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, or pancreas, omentum or extrahepatic bile ducts T4 Tumor invades main poal vein or hepatic aery, or invades multiple extrahepatic organs or structures Regional lymph nodes (N) NX Regional lymph nodes cannot be assessed NO No regional lymph node metastasis NI Regional lymph node metastasis Distant metastasis (M) MX Distant metastasis cannot be assessed MO No distant metastasis M1 Distant metastasis Stage grouping Stage 0 Tis NO MO Stage IA T1 NO MO Stage IB T2 NO MO Stage IIA T3 NO MO Stage IIB T1 T2 T3 NI NI N1 MO MO MO Stage III T4 Any N MO Stage IV Any T Any N M1 For stage Ia: Tla staged tumors (tumors confined to lamina propria)? - These tumors are recognized incidentally at the time of pathologic review. No fuher t/t is needed. Simple cholecystectomy is sufficient for them. - In laparoscopic cholecystectomy, recurrent cancer has been seen at the po site. Hence all po sites should be excised. - Patients with preoperatively suspected gallbladder cancer should under go open cholecystectomy to minimize the chances of tumor dissemination. Tlb staged tumors (tumors invading muscular layer)? - Invasion of the muscular layer allows access to lymphatics and vessels. For Tlb staged tumors, an extended cholecystectomy is indicated, as these tumors have been repoed to recur after simple cholecystectomy. For stage Ib, II, selected stage III tumors: - These are managed by extended cholecystectomy. Stage IV tumors: - Should be treated with appropriate palliation as indicated. No randomized data have demonstrated improved survival with either chemotherapy or radiation and its use depends on case to case basis.
Category:
Surgery
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now