Immediate radical cholecystectomy for suspected gallbladder cancer identified intraoperatively: a case report

Abstract

Gallbladder cancer (GBC) is the most common malignancy of the biliary tract and is associated with poor prognosis due to its aggressive biological behavior and frequent diagnosis at advanced stages. Preoperative diagnosis remains challenging, and a significant proportion of cases are detected incidentally or suspected only during surgery performed for presumed benign gallbladder disease. For tumors staged T1b or higher, current international guidelines recommend radical cholecystectomy with hepatic resection of segments IVb and V and regional lymphadenectomy to achieve adequate oncological control. However, the optimal timing of extended resection when malignancy is suspected intraoperatively remains controversial. We report the case of a 78-year-old woman undergoing evaluation for gastroesophageal reflux disease in whom abdominal ultrasonography revealed a gallbladder fundal lesion suspicious for malignancy. Contrast-enhanced thoracoabdominopelvic computed tomography showed no evidence of distant metastases or invasion of adjacent structures. The patient was scheduled for laparoscopic cholecystectomy with the possibility of extended resection depending on intraoperative findings. During laparoscopy, macroscopic features highly suggestive of malignancy were identified, prompting conversion to open surgery and immediate radical cholecystectomy with non-anatomical resection of liver segments IVb and V and regional lymphadenectomy. Histopathological examination confirmed invasive biliary-type gallbladder adenocarcinoma staged as pT2N0M0 (stage IIA) with negative surgical margins (R0). The postoperative course was uneventful, and adjuvant systemic therapy was initiated. Immediate radical cholecystectomy during index surgery may represent a feasible and oncologically sound approach when GBC is suspected intraoperatively.