A 58-year-old woman presents to the surgical outpatient department with a 4-month
history of progressively worsening right upper quadrant pain, early satiety,
pruritus, and a 10 kg unintentional weight loss. She also reports intermittent low-
grade fever and recent onset of jaundice over the past two weeks. There is no
history of prior biliary surgery.
On examination, she is icteric, with mild hepatomegaly and tenderness in the right
hypochondrium. No palpable mass is noted. Vital signs are stable. There is scratch
marking on her limbs, and BMI is 19 kg/m².
Lab findings are :Bil: 5.2 mg/dL ALP: 740 IU/L, GGT: Elevated,AST/ALT:
Mildly raised,CA 19-9: 380 U/mL,CEA: 7.1 ng/mL
CT scan shows A 4.2 cm irregular enhancing mass arising from the fundus and body
of the gallbladder. Direct infiltration into segments IVb and V of the liver (2.5 cm
depth).Loss of fat plane with the first part of the duodenum. Multiple periportal and
peripancreatic lymph nodes (largest 1.6 cm).No evidence of peritoneal or distant
metastasis
Questions:
1.Discuss the multidisciplinary management approach for this patient, including
surgical options.
2. Outline the criteria for resectability in gallbladder carcinoma. Based on the
given scenario, what factors may indicate borderline or unresectable disease?
3. What is the role of staging laparoscopy in this patient? What findings would
alter the management plan?
4. Explain the prognostic indicators in gallbladder carcinoma and the
expected outcome for this patient if curative resection is not feasible.
5. What is the role of biliary drainage in Gall bladder Ca and the need for systemic
therapy.
