Carcinoma Gall bladder
Route of spread- Hepatic > Lymphatic > Perineural
MC route of spread- Direct hepatic invasion
Generally, GB cancer is an adenocarcinoma
Most specific marker- CA 19-9
IOC for CA bladder- CEC 19-9
8TH AJCC (2017) TNM classification
- T1A - involvement of lamina propria
- T1B - involvement of muscularis propria
- T2A - invasion of perimuscular connective tissue
towards peritoneal side without extension to serosa - T2B - invasion of perimuscular connective tissue
towards hepatic side without direct hepatic invasion - T3 - serosal perforation or direct hepatic invasion
or involvement of single extrahepatic organ - T4 - involvement of portal vein or hepatic artery or
two or more extrahepatic organ - N1 - metastasis to 1 - 3 lymph nodes
- N2 - metastasis to 4 or more lymph nodes
- Mo - no distant metastasis
- M1 - distant metastasis
Staging
IA -Tla -
Lap cholecystectomy
- 18 - T1b
- 11A - T2a
–118 - T2b - IIIA-T3
- IIIb - T1-3 N1
Extended cholecystectomy
IVA - T4 N0-1
Extended cholecystectomy+Extended R hepatectomy
IVB-T any M2.
IVB - Tany M2
T any N any M2.
Palliation (we give chemotherapy)
Extended cholecystectomy- Enbloc removal of IVb
and V segments of liver + gallbladder+
LN along cystic duct, CBD, Periportal and
Retropancreatic LN.
Port site excision
Whenever pneumoperitoneum is created during laparoscopic procedures, the port is inserted.
Sometimes tumor gets deposited around the port by chimney effect.
So circumferentially tumor is excised around the port and is known as Port site excision Presence of tumor cells at port site- poor prognosis
Absence of tumor cells at port site- good
prognosis