Soldier’s mother having advanced gall bladder cancer treated successfully!

20 Jan, 2023

A 57-year-old lady, underwent surgery for gall bladder stones. Biopsy of removed gall bladder was suggestive of cancer of gall bladder). PET CT showed a large residual tumour with extensive involvement of the blood vessels supplying the right side of liver with lymph nodal involvement.

Surgery allows for best chance at cure in most patients with gall bladder cancer. In patients with late stage I and stage II gall bladder cancer (including those with incidental gall bladder cancer), removing the residual gall bladder with part of adjacent liver, and surrounding lymph nodes (surgery called radical cholecystectomy) is recommended. However, insome patients in which the tumour extends to involve the bile duct or vessels supplying the right side of liver, it requires removal of a larger part of liver along with the tumour (surgery called extended hepatectomy) to achieve cancer free state. To ensure that the remnant liver functions normally after surgery, we also performed a procedure called portal vein embolization 4 weeks before the main surgical procedure. This procedure is usually done under local anaesthesia in Cath lab where blood supply to the part of liver that is to be removed is blocked temporarily so as to allow remnant liver to get time to grow in size before the final surgery.

We also gave short course of chemotherapy prior to surgery to help achieve best survival outcome of treatment to this patient with stage 3 gall bladder cancer in accordance with best practices across the world. Patients with jaundice need some procedure (preferably PTBD on the planned remnant side) to improve jaundice prior to starting chemotherapy. Carefully selected interventions performed before surgery, helped us to substantially decrease surgical risks in our patient. We could successfully perform complete surgical resection of the tumour and other involved tissues as planned in an 8 hour long surgery (Extended right hepatectomy with Common Bile Duct (CBD) excision with hepaticojejunostomy). The patient recovered well after the surgery, is free of tumour, and is doing well.

It is extremely important for patients to have the steps of their treatment clearly planned out at start of treatment and then getting executed flawlessly with clock-work precision for best outcomes as a failure at any step could prevent the patient from having curative surgery. Also, All gall bladders removed surgically should to be sent for biopsy evaluation as about 1% patients may have hidden cancer (called incidental gall bladder cancer) in the removed gall bladder and can be offered curative treatment if disease is diagnosed even at this point.