EXTENDED MULTI-ORGAN SURGERY FOR THE TREATMENT OF GALLBLADDER CANCER: CASE REPORT AND LITERATURE REVIEW

Case Report: Female, 44 years old, abdominal pain, choluria and fecal padding, loss of 7kg in the last 30 days. She reported previous pancreatitis 15 days before, being submitted to endoscopic retrograde cholangiopancreatography and stent placement. On clinical examination, the patient presented icteric, afebrile, eutrophic, with abdomen without signs of peritoneal irritation or masses. Total abdominal ultrasonography identified gallbladder with multiple calculous formations and bile duct dilatation. Total bilirubin of 18 (direct 14.4) and increased canalicular enzymes; Ca 19-9 153, CEA 1. In the cholangioresonance observed bile duct dilatation, the abrupt reduction in the junction of the hepatic ducts and hepatocolledoco; the presence of images suggestive of gallstones in hepatocolledoco and bile duct, pancreas with increased heterogenicity in the cephalic area. During the procedure: gallbladder lesion with hepatic invasion in segment IV and proximal colledochus, without vascular involvement. A proximal pancreatectomy was performed, with duodenal resection, cholecystectomy, segment IV and V hepatectomy, biliary tract hepatectomy, and lymphadenectomy. Resection in monoblock, with anastomosis in a single loop. Pathological anatomy: adenocarcinoma, infiltrating hepatic parenchyma, gallbladder wall, choledochus, and duodenal papilla. No neoplasia in the pancreatic and biliary margins and presence of metastasis in 2/7 lymph nodes of the hepatic hilum. Discussion: Gallbladder cancer (GBC) has a low incidence and high mortality. Most patients are diagnosed incidentally. The risk of gallbladder cancer is usually related to chronic cholecystitis. The symptoms are nonspecific, biliary colic-like. Staging is preferably done with cholangioresonance and histology predominates adenocarcinomas. Irresectability criteria are distance metastasis, affected lymph nodes, and invasion of large vessels. There is no consensus on adjuvant therapy, performed with chemoradiotherapy. Conclusion: Surgery is the only cure option for GBC. The case described shows an atypical initial presentation of abrupt evolution. It should be noted that cholestatic icterus may be an initial manifestation of this suspected neoplasm with progression in malaise and weight loss. The medical decision should address the surgeon's experience, as well as the possibility of resectability without increased mortality for the patient.

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Artikel online veröffentlicht:
23. Oktober 2019