Carcinoma Gall bladder

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  • Carcinoma Gall bladder
    • majority are adenocarcinomas.(MCQ)
    • Extremely rare (< 1% of patients with cholelithiasis) (MCQ)
    • incidence increases with age with a peak at 75 years (MCQ)
    • female:male ratio 3:1 (MCQ)
    • Risk factors (MCQ)
      • porcelain gallbladder
      • gallstones, choledochal cysts
      • gallbladder polyps
      • typhoid carriers with chronic inflammation.
    • Signs and symptoms (MCQ)
      • Most patients are asymptomatic until late in the course
      • findings may include abdominal pain, nausea, vomiting, weight loss, RUQ mass, hepatomegaly, or jaundice.
    • Diagnosis – Ultrasound, CT, MRI, or ERCP/PTC
    • Treatment
      • Tumor confined to gallbladder mucosa: Cholecystectomy (MCQ)
      • Tumor involving muscularis or serosa: (MCQ)
        • Radical cholecystectomy
        • Wedge resection of overlying liver
        • lymph node dissection
      • Tumor involving liver: (MCQ)
        • Consider palliative measures such as decompression of the proximal biliary tree or a bypass procedure of the obstructed duodenum

Clinical Pearls :

        • Courvoisier’s sign: A palpable, nontender gallbladder often associated with cancer in the head of the pancreas or the gallbladder. (MCQ)
        • The diagnosis is made on ultrasonography and defined by a multidetector row CT scan, with a percutaneous biopsy confirming the histological diagnosi
        •  In selected patients, laparoscopy is useful in staging the disease, as it can detect peritoneal or liver metastases that would preclude further surgical resection.

      Gallbladder Cancer
      Laparoscopic completion radical chlocystectomy and lymphadenectomy for T1b gallbladder cancer
      The art of laparoscopic cholecystectomy – gallbladder cancer
      Dissection of the gallbladder and operative cholangiogram for suspicion of malignancy located in the gallbladder fundus: no touch technique — the gallbladder is not manipulated or dissected until the vascular supply and drainage is disconnected and the cystic duct is clipped and divided. The omental adhesions around the gallbladder fundus are removed en-bloc; the liver is retracted with a Nathanson’s liver retractor without touching the gallbladder; the peritoneum is incised over the hepatic artery and the CBD and hepatic duct are skeletonised to the confluence of the left and right hepatic ducts; the right hepatic artery is also displayed; the soft tissue from the duodenum to the confluence of the duct is removed en-bloc with the gallbladder; a short cystic duct is demonstrated, clipped and divided; the gallbladder is dissected and placed into an endobag — a fine duct of Luschka draining the gallbladder fundus is demonstrated; operative cholangiogram with demonstration of the anatomy of the biliary tree is performed and the very short cystic duct stump is suture-ligated with 3/0 PDS flush to the common bile duct; no bleeding, no bile spillage, no tumour manipulation.
      Gall Bladder Carcinoma with Invasion of the Common Bile Duct
      Abstract: At endoscopic retrograde cholangiopancreatography (ERCP), the differentiation of malignant from benign ductal abnormalities often remains difficult, but is essential for therapeutic management. We demonstrate the case of a 72-year-old woman with a very discrete irregularity of the common bile duct on ERCP that was further evaluated by cholangioscopy. This article is part of an expert video encyclopedia.
      Gall bladder cancer symptoms pictures
      Gall bladder cancer symptoms
      04-02-2012 Multiport Laparoscopic Surgery (Carcinoma Gallbladder)
      Carcinoma Gallblader
      Histopathology/ Moderate to poor differentiated adenocarcinoma extending to GB neck resection margins pT3; perforating visc peritonium invading fat, no venous /lymph /perineu inv
      Gallbladder Cancer Resection – Subhepatic Dissection
      HPBA2009 DVD 22: Invited Video Session: LIVER I
      Featured video preview: Subhepatic Dissection with Lymphadenectomy and Partial Hepatectomy for Gallbladder Cancer by William R. Jarnagin, MD, FACS. Full length of his session is 00:10:55 run time. The length of full DVD 22 ( 4 sessions in total) is 00:43:31 run time of LIVE SURGERY ! … see details medicaldtv com, look for AHPBA 2009
      Gallbladder Disease – A Brief Look At Gallbladder Disease
      Gallbladder disease can be painful and difficult to live with. This video looks at what can cause the various kinds of gallbladder disease, and their effects. Consider your risk of gallbladder disease and what you can do to to prevent it.