What should be the plan of patient who undergoes Laparoscopic cholecystectomy, specimen showed T2 Gallbladder Cancer?
Ans. (a) Relaparotomy and resect Segment 4b - 5, dissection of N1-2 nodes with port sitesRef: Bailey and Love 27th edition Page 1211If specimen says* T1 a- Already done cholecystectomy is enough* T1 b- Cholecystectomy is enough if margins are negative* T1 b (if has Perineural, vascular invasions) - risk of nodal involvement is more - hence Extended Cholecystectomy is done.* In extended cholecystectomy 2cm of normal hepatic parenchyma is to be removed, CBD should be removed if cystic duct margin is positive and all the nodes Pericholedochal, periportal, Hepatoduodenal. Coeliac and posterior pancreatico duodenal nodes are removed.* T2 - Cases Radical cholecystectomy involving removal of segment 4b and 5 along with nodes.* T3- Radical cholecystectomy or Extended Right Hepatectomy is done* If only segment 5 was involving removal of Segment 4b and 5 would have been done* Some cases will also require a central hepatectomy- Removal of segments 4, 5 and 8* Some cases will also need Right Trisegmentectomy- Removal of segments 5,6,7,8 and segment 4
Relaparotomy and resect Segment 4b - 5, dissection of N1-2 nodes with port sites
Post op Chemotherapy alone
Extended Cholecystectomy
Whipple procedure
Gall Bladder & Bile Ducts