Thanks Dr Reddy

For stage T1a, simple cholecystectomy is the answer.

Your case is a stage T1b:

The usual management is EXTENDED CHOLECYSTECTOMY.Additional lymph nodes removal and 2.5 cm of the liver bed resection.

The decision is to be taken within the context of UGI MDT.If no such system,

Then patients comorbidities and fitness for another surgery, patients wishes, hepatic surgery expertise are the main factors in decision process.

Thanks MrHussain,will Gemcitabine cisplatin combination has any role when the PET is negatve and CA199 is normal.

The removal of the gallbladder is enough

I had such case 2 years ago. Conditions were the very same. Consilium was decided not to operate again. Patient is normal till now

I had a similar case three months ago but with insitu neoplasia and moderate dysplasia in the cystic dust so I performed extrahepatic bile dust removal and a hepaticojejunostomy. For the gallbladder T1b adenocarcinoma I performed liver bed resection. The tumor board decided no adjuvant treatment

it is pT2 lesion, the recomendation is radical cholecystectomy. one half of patients with pT2 lesion harbour nodal metastasis. diagnostic lap followed by aortocaval LN frozen section and if above two are negative then proceed for radical cholecystectomy, which is the only hope of hope.

Thankyou all,we have offered Re surgery or chemo.But pt prefers followup only.I feel and some of our colleagues mentioned this is also an option to consider as in our experience incidental GB carcinoma when we reoperated majority had normal Liver bed with out any evidence of tumour infiltration.

 I think is a good option to wait and see what happens with a strict and continued follow-up period surveillance

Primary surgery is usually curative . Your patient is 70 diabetic and has made the correct decision. Chemo is toxic .

For incidental gallbladder cancer at this stage we usually reoperate and perform extended lynphadenectomy and resection of liver segments 5 and 4b. We have been used laparoscopic approach lately in selected cases with good results. However we understand that the final decision should be done by the patient.

Article Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hi...

Thankyou,Following radical surgery Histopathology is negative for tumour.This is what our experience also.Hence wefollow these patients without second surgery.Ofcourse I fully endorse the laid down protocol is the second stage radical recection .Some are treating with Gemcitabine.

It is just over one year since lap chole,pt is being followed regularly.she is well ,LFT,CA19-9 and U/s and and CT are normal.she is not on any chemo medication.

To remove the gallbladder anyway

15 months later she developed local recurrence involving the liver bed with duodenal obstruction,

CA19-9 is 700.No jaundice,what next ?

There is no stablished protocol for these cases. Usually removal of the gallbladder is enough, but of course in some cases may be a local recurrence like in this description