In gallbladder carcinoma, T2 disease (tumour invading perimuscular connective tissue, not beyond serosa) found incidentally after laparoscopic cholecystectomy — what is the recommended surgical management?

• A No further surgery required; surveillance only
• B Completion total hepatectomy with liver transplantation
• C Chemotherapy with gemcitabine-cisplatin without re-resection
• D Re-resection with 2-cm hepatic bed resection (segments IVb and V) plus regional lymphadenectomy (hepatoduodenal ligament) ✓

Explanation

Incidentally discovered T2 gallbladder carcinoma (invading perimuscular connective tissue) requires re-resection because the original laparoscopic cholecystectomy violates oncological principles. Standard re-resection includes hepatic bed resection of segments IVb and V with a 2-cm margin, regional lymphadenectomy including hepatoduodenal ligament nodes, and excision of any port sites if bile spillage occurred. T1b tumours may require hepatic bed resection; T3-T4 tumours require more extensive hepatectomy with bile duct resection if involved. The 5-year survival for R0-resected T2 disease is approximately 60-70%.

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

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Written and medically reviewed by the StethoPrep medical team.