Gallbladder carcinoma incidentally found on histology after laparoscopic cholecystectomy is staged T1b (muscle layer invasion, not beyond). The correct management is:

• A Re-excision is not required; cholecystectomy alone is curative for T1b disease
• B Adjuvant gemcitabine-cisplatin chemotherapy without re-operation
• C Re-operation with en-bloc hepatic segment IVb/V resection plus portal lymphadenectomy ✓
• D Extended right hepatectomy plus bile duct excision is mandatory for T1b

Explanation

T1b gallbladder carcinoma (invades the muscular layer but not perimuscular connective tissue) is managed with simple cholecystectomy for T1a; for T1b, guidelines recommend re-excision with hepatic segment IVb/V resection to achieve a clear deep margin and regional lymphadenectomy. Simple cholecystectomy alone carries a significant recurrence risk for T1b because the perimuscular tissue and regional nodes are not addressed. Extended hepatectomy with bile duct excision is required for T2/T3 disease with ductal involvement, not for T1b.

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

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Written and medically reviewed by the StethoPrep medical team.