Related Experiment Video
Updated: Nov 20, 2025
Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
Published on: January 17, 2025
[A Case of Gallbladder Cancer with Para-Aortic Lymph Node Metastasis Successfully Treated by Gemcitabine plus
Tomokatsu Kato1, Yoichi Matsuo, Goro Ueda
1Dept. of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences.
Insights
This gallbladder cancer case shows successful conversion surgery after neoadjuvant chemotherapy. Multimodality treatment enabled tumor resection in advanced gallbladder cancer.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Oncology
Background:
- Gallbladder cancer with para-aortic lymph node metastasis typically has a poor prognosis.
- Early detection and accurate staging are crucial for treatment planning.
Observation:
- A 59-year-old woman presented with elevated CA19-9 and gallbladder wall thickening.
- Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed undifferentiated gallbladder cancer with lymph node metastasis.
- FDG-PET revealed tumor involvement in the gallbladder and para-aortic lymph nodes, deeming the cancer unresectable.
Findings:
- Neoadjuvant chemotherapy (gemcitabine plus cisplatin) led to significant tumor response, including reduced lymph node size and decreased FDG uptake.
- Conversion surgery, including extended cholecystectomy and extrahepatic bile duct resection, was successfully performed.
- Histopathological examination confirmed complete tumor resection with no residual cancer cells.
Implications:
- Multimodality treatment, including neoadjuvant chemotherapy followed by conversion surgery, can be a viable strategy for initially unresectable gallbladder cancer.
- This approach may improve outcomes for patients with advanced gallbladder cancer and lymph node metastasis.
- Further research into conversion surgery for gallbladder cancer is warranted.
Abstract:
The case is a 59-year-old woman. A medical examination revealed a high CA19-9, she visited a nearby hospital. Abdominal echo showed thickening of the gallbladder wall, and she was referred to our hospital for further examination. EUS-FNA was performed and a biopsy of #12 lymph node revealed undifferentiated cancer, which was diagnosed as gallbladder cancer. FDG-PET showed accumulation of FDG in the gallbladder lumen and swollen lymph nodes around the aorta. Therefore, the cancer was considered unresectable and chemotherapy was performed. FDG-PET was re-examined after 4 courses of gemcitabine plus cisplatin combination chemotherapy. As a result, the lymph node swelling contracted, the accumulation of FDG disappeared, and surgery was scheduled. Extended cholecystectomy and extrahepatic bile duct resection were performed. She was discharged 22 days after the surgery without complications. Histopathological examination showed fibrotic tissue at the gallbladder and lymph nodes, but no residual tumor cells. There are no recurrences 11 months after surgery. Although the prognosis of gallbladder cancer with para-aortic lymph node metastasis is generally poor, it is suggested that conversion surgery with multimodality treatment including preoperative chemotherapy may be a useful therapeutic strategy.
More Related Videos
13:56Robot Assisted Distal Pancreatectomy with Celiac Axis Resection DP-CAR for Pancreatic Cancer: Surgical Planning and Technique
Published on: August 14, 2021
12:07Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer
Published on: November 18, 2022