In a male after un event full laparoscopic cholecy-stectomy, specimen is sent for histopathology which shows carcinoma gallbladder stage 1a. appropriate management is
|A||Conservative and follow up|
|C||Excision of all port sites|
AJCC cancer staging manual, sixth edition
TNM staging gallbladder cancer
Definition of TNM
Primary tumor (T)
b. TO - No evidence of primary tumor
c. Tis - Carcinoma in situ
d. Tl - Tumor invades lamina propria or muscle layer
e. T1a -Tumor invades lamina propria
f. T1b - Tumor invades muscle layer
g. T2- Tumor invades perimuscular connective tissue; no extension beyond serosa or into liver
h. T3 – Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, or pancreas, omentum or extra hepatic bile ducts
i. T4 - Tumor invades main portal vein or hepatic artery, or invades multiple extrahepatic organs or structures
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Distant metastasis (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
Stage 0 Tis N0 M0
Stage IA Tl N0 M0
Stage IB T2 N0 M0
Stage IIA T3 N0 M0
Stage IIB Tl Nl M0
T2 Nl M0
T3 Nl M0
Stage III T4 Any N M0
Stage IV Any T Any N Ml
Management of Stage I
Patients with tumors confined to the gallbladder mucosa or submucosa (T1a / stage IA) or confined to the muscularis (T1b stage ill) are usually identified after cholecystectomy for the gallstones.
Cholecystectomy is adequate for stage I tumors.
a. In laparoscopic cholecystectomy, recurrent cancer has been seen at the port site. Hence all port sites should be excised.
b. Patient preoperatively suspected gallbladder cancer should under go open cholecystectomy to minimize the chances of tumor dissemination.
Management of Stage II and Stage IIII
a. Cancer of the gallbladder with invasion beyond the gallbladder muscularis is managed with extended cholecystectomy 'this includes lymphadenectomy of the cystic duct, peri choledochal, portal, right celiac, and posterior pancreatoduodenal lymph nodes.
b. Achieving a margin negative resection should be the goal of surgery.
c. For tumor invading liver extended cholecystectomy Qincludes at least 2-cm margin Qof liver beyond the palpable or sonographic invasion of the tumor.
d. For smaller tumors negative margin can be achieved by wedge resection of liver Q.
e. For larger tumor, an anatomic liver resection (extended right hepatectomy) Q may be required to a histologically negative margin.
f. For unresectable tumors palliative therapy Qis the management.