A 60-year-old woman undergoes elective laparoscopic cholecystectomy for symptomatic gallstones. On post-operative review of the pathology report, the gallbladder specimen shows incidental T1b gallbladder carcinoma (tumour invading perimuscular connective tissue, not beyond). What is the appropriate management?

• A Chemotherapy with gemcitabine-cisplatin
• B Simple cholecystectomy (already performed) is sufficient — no further surgery
• C Port site excision only
• D Re-resection with radical cholecystectomy (liver bed resection + lymphadenectomy) ✓

Explanation

For T1b gallbladder carcinoma (invasion of perimuscular connective tissue), simple cholecystectomy has recurrence rates of ~20–40%, and re-resection with radical cholecystectomy (2 cm liver bed resection) plus regional lymphadenectomy is recommended by NCCN and AHPBA guidelines. T1a tumours (limited to mucosa) can be managed with simple cholecystectomy alone. For T1b and beyond, radical re-resection improves 5-year survival significantly.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.