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Laparoscopic Management of Suspected Gallbladder Cancer: Risk Stratified Approach in Thick-Walled Gallbladder and
Nikhil Agrawal1,2, Anjali Singh3, Manish Jain3
1GI-HPB Surgical Oncology, Max Super Speciality Hospital Saket, New Delhi, India. drnkhl@gmail.com.
Introduction:
Thick-walled gallbladder (TWGB) and gallbladder polyps (GBP) can harbour cancer. Differentiating benign from malignant is challenging owing to the limitations of diagnostic studies and unreliability of predictive models. Simple or radical cholecystectomy pose risks of either inadequate oncological clearance or overtreatment. While anticipatory extended and cystic plate cholecystectomy with frozen section is useful but has limitations and laparoscopic approach with risk stratification is not well documented.
Methods:
In this retrospective study, 39 patients with TWGB or GBP suspected of malignancy were stratified into very low-risk and low-risk based on clinical, radiological, and intraoperative findings. Those with very low-risk underwent laparoscopic cystic plate cholecystectomy (LCPC), whereas those with low-risk underwent laparoscopic anticipatory extended cholecystectomy (LAEC). If frozen section showed malignancy, additional surgical procedures were performed.
Results:
Of the 39 patients, 25 underwent LAEC, ten LCPC and four simple cholecystectomies. Eight patients (20.5%) had cancer on frozen and underwent completion surgery. The mean operative time was 3.34 ± 1.77 h, and the mean hospital stay was 3.66 ± 1.72 days. Clavien-Dindo ≥ 3 morbidity occurred in four patients (10.2%).
Conclusions:
Managing TWGB or GBP with suspicion of cancer requires balancing oncological safety with overtreatment. A risk-stratified laparoscopic approach with frozen section is safe and effective.
