Ann Hepatobiliary Pancreat Surg.  2022 Feb;26(1):113-117. 10.14701/ahbps.21-071.

Curative intent radical cholecystectomy followed by hyperthermic intraperitoneal chemotherapy in ruptured intraductal papillary neoplasm of gallbladder with invasive carcinoma

• Choi G
• Jang S
• Choi M
• Yang S
• Lee C
• Kang CM

• KMID: 2526840
• DOI: http://doi.org/10.14701/ahbps.21-071

Abstract

Gallbladder cancer has a poor prognosis, especially in peritoneal carcinomatosis related to perforation of the gallbladder followed by bile spillage. Previously, curative-intent treatment was not considered in carcinomatosis from cancer of the biliary tract. A 72-year-old male was referred to the hospital with a perforated gallbladder cancer. Intraoperatively, the tumor was confined to the gallbladder and liver. We presented a case of intention-to-curative resection of perforated gallbladder cancer followed by intraoperative hyperthermic intraperitoneal chemotherapy.

Keyword

Gallbladder cancer; Peritoneal carcinomatosis; Hyperthermic intraperitoneal chemotherapy; Cholecystectomy

Figure

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  Fig. 1 Preoperative findings. Computed tomography (CT) scan shows a distended gallbladder (GB) with multiple polypoid lesions and irregular GB wall thickening (white arrows, A). Note pericholecystic tumor extension due to perforation of the GB (white star, B). Positron emission tomography-computed tomography shows heterogeneous hypermetabolic lesion along GB wall (white arrows) and in the distal portion of the common bile duct (white thick arrow, C).

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  Fig. 2 Intra-operation findings. Localized peritoneal seeding was noted around GB and omentum (A). Omentum covering the perforated portion of the GB, adherent to colon and duodenum (B). Pylorus preserving pancreaticoduodenectomy (PPPD) was performed with right hemicolectomy to remove the minimal peritoneal seeding around GB. Dotted circle indicates surgical field after PPPD (C). Surgical field after curative intent PPPD (white arrow, aberrant right hepatic artery from superior mesenteric artery) (D). Operation room view for intraoperative HIPEC with mitomycin-C (E). Indwelling two-way catheter for continuous circulation of chemotherapeutic agent with temporary closure of the abdominal wound (F). Om, omentum; GB, gallbladder; C, colon; D, duodenum; PV, portal vein; SMV, superior mesenteric vein; IVC, inferior vena cava; BD, bile duct; P, pancreas; HIPEC, hyperthermic intraperitoneal chemotherapy.

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  Fig. 3 Change of absolute neutrophil count after surgery. ANC was improved after injecting G-CSF on POD #14 (thick white arrow). ANC, absolute neutrophil count; G-CSF, granulocyte-colony stimulating factor; POD, postoperative day.

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  Fig. 4 Surgical specimen. En-block resection was performed for perforated GB cancer (white arrows, sealed up perforation site) (A). Individual surgical specimens were outlined. Thin white line, resected colon area; thick white line, surgical specimen of PPPD; white dotted line, omentum (B). BD, bile duct; T, tumor; GB, gallbladder; C, colon; Cprox, proximal colon; D, duodenum; P, pancreas; Om, omentum.

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