If post op gall bladder ca comes as T1b..ans should be radical or extended cholecystectomy..?

For a postoperative diagnosis of T1b gallbladder cancer, the recommended treatment is a radical or extended cholecystectomy. Here’s the reasoning:

T1b Gallbladder Cancer

  • Definition: T1b stage indicates that the tumor has invaded the muscular layer (muscularis propria) of the gallbladder wall but not beyond.
  • Significance: This level of invasion carries a higher risk of lymph node involvement and local spread compared to T1a (which is confined to the lamina propria).

Treatment Recommendations

  1. Radical or Extended Cholecystectomy:
  • Procedure: Includes the removal of the gallbladder (if not already removed), a wedge resection of the liver bed (segments IVb and V), and regional lymphadenectomy (removal of lymph nodes in the hepatoduodenal ligament).
  • Rationale: Ensures complete removal of potentially involved tissues and lymph nodes, reducing the risk of residual disease and recurrence.
  1. Comparison with Simple Cholecystectomy:
  • Simple Cholecystectomy: Typically sufficient for T1a tumors but inadequate for T1b tumors due to the deeper invasion into the muscle layer.
  • Radical Cholecystectomy: Offers a more thorough treatment approach for T1b to address the higher risk of local spread and lymph node metastasis.

Clinical Guidelines

  • NCCN Guidelines: The National Comprehensive Cancer Network (NCCN) and other clinical guidelines recommend a radical or extended cholecystectomy for T1b gallbladder cancer.
  • Evidence-Based Practice: Studies have shown that radical cholecystectomy improves survival outcomes for patients with T1b tumors compared to simple cholecystectomy.

Conclusion

For T1b gallbladder cancer, radical or extended cholecystectomy is the recommended treatment to achieve complete tumor removal and address potential lymph node involvement. This approach provides a better chance for cure and long-term survival.