Ann Hepatobiliary Pancreat Surg.  2019 Feb;23(1):69-73. 10.14701/ahbps.2019.23.1.69.

Laparoscopic radical cholecystectomy with common bile duct resection for T2 gallbladder cancer

• Navarro JG
• Kang CM

• KMID: 2439049
• DOI: http://doi.org/10.14701/ahbps.2019.23.1.69

Abstract

The oncologic safety and feasibility of laparoscopic radical cholecystectomy for a preoperatively suspected gallbladder cancer is continually being challenged even in an era of minimally invasive surgery. A seventy-four-year-old woman was presented in the outpatient department with a history of fever, abdominal pain, and vomiting. CT scan showed an irregular wall thickening of the body to the cystic duct of the gallbladder and portocaval lymph node. In addition, EUS revealed no subserosal invasion of the tumor. PET scan showed an intense FDG uptake of in the gallbladder and in the portocaval lymph node. The laparoscopic radical cholecystectomy was performed with 6 trocars. The procedure included simple cholecystectomy, hepatoduodenal and aortocaval lymphadenectomy, and common bile duct resection. The hepaticojejunal anastomosis was constructed laparoscopically, while the jejunal continuity was established via an extracorporeal anastomosis. The patient was discharged on the 7th postoperative day with no complications and adjuvant chemotherapy was started on the 14th day after surgery. Based on our experienced, laparoscopic radical cholecystectomy with combined common bile duct resection is technically safe and feasible.

Keyword

Gallbladder cancer; Radical cholecystectomy; Common bile duct resection; Hepaticojejunostomy

MeSH Terms

Abdominal Pain
Chemotherapy, Adjuvant
Cholecystectomy*
Common Bile Duct*
Cystic Duct
Female
Fever
Gallbladder Neoplasms*
Gallbladder*
Humans
Lymph Node Excision
Lymph Nodes
Minimally Invasive Surgical Procedures
Outpatients
Positron-Emission Tomography
Surgical Instruments
Tomography, X-Ray Computed
Vomiting

Figure

• 

  Fig. 1 Preoperative imaging study. (A) Computed tomography scan showing irregular wall thickening of the body to the cystic duct of the gallbladder (green arrow) and portocaval lymph node (white arrow), (B) Endoscopic ultrasound showing intraluminal mass lesion at the neck of the gallbladder without subserosal invasion (yellow arrow) and intraluminal stone (white arrow). (C) Endoscopic ultrasound showing cystic duct involvement of the tumor, (D) Positron emission tomography scan showing intense FDG uptake of in the gallbladder and in the portocaval lymph node (white arrow).

• 

  Fig. 2 Placement of trocars in laparoscopic radical cholecystectomy.

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  Fig. 3 Intraoperative pictures. (A) Lymph node dissection included station 7, 8, 9, 12, 13, and 16. (B) Completed Roux-en-Y hepaticojejunostomy. PHA, proper hepatic artery; CBD, common bile duct; PV, portal vein; IVC, inferior vena cava; LRV, left renal vein.

• 

  Fig. 4 Specimen image showing gross morphology of the gallbladder tumor and extent of tumor invasion near the cystic duct (white arrow). Note the segment of common bile duct (CBD) (*).

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