In a patient with gallbladder carcinoma found incidentally after laparoscopic cholecystectomy (T2 lesion — tumor invades the perimuscular connective tissue), what is the recommended management?

• A No further surgery required as margins are clear on pathology
• B Adjuvant chemotherapy with gemcitabine alone without re-operation
• C Port-site excision, re-resection of the gallbladder fossa with 2 cm hepatic margin, and regional lymphadenectomy ✓
• D Right hemihepatectomy and pancreaticoduodenectomy in all T2 cases

Explanation

Incidental T2 gallbladder carcinoma (tumor invades perimuscular connective tissue, not through it) found after cholecystectomy requires: (1) port-site excision to prevent port-site implants from bile spillage, (2) re-resection of the gallbladder fossa (liver segments IVb and V) with a 2 cm margin, and (3) hepatoduodenal ligament lymphadenectomy. T1b and T2 tumors require re-resection for adequate staging and potential cure. T1a tumors (limited to mucosa) do not require re-resection if margins are clear. Extended hepatectomy (right hemihepatectomy + pancreaticoduodenectomy) is only for T3/T4 disease with direct invasion.

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

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Written and medically reviewed by the StethoPrep medical team.