Long-term survival after multidisciplinary therapy for residual gallbladder cancer with peritoneal dissemination: a case report

Abstract

BackgroundAlthough surgical resection is the only curative treatment for gallbladder cancer (GBC), concomitant peritoneal dissemination is considered far beyond the scope of resection. We report a long-term survivor with a residual GBC with multiple peritoneal disseminations who underwent an extended resection after effective chemotherapy.Case presentationA 59-year-old male underwent an open cholecystectomy for Mirizzi syndrome at a local hospital. Because of severe inflammation, the gallbladder was perforated during surgery, ending in a piecemeal resection. A pathological examination revealed GBC with positive margins, and the patient was referred to our hospital 1 month after surgery for further treatment. A multidetector-row computed tomography (MDCT) showed three hypoattenuated tumours: a tumour (3.9 cm) at the left medial segment corresponding to the gallbladder bed, a tumour (1.8 cm) around the hepatic flexure of the transverse colon, and a tumour (1.0 cm) at the stump of the cystic duct. Percutaneous needle biopsy was performed, which provided histologic evidence of adenocarcinoma. Thus, the patient had a rapidly progressive local relapse with limited peritoneal dissemination, labelled ycT3N0M1, stage IVB disease according to the UICC system. After the administration of 3 cycles of gemcitabine plus cisplatin combination chemotherapy, the size of all tumours and the CA19-9 level decreased significantly. Since the patient’s general condition and liver function reserve were satisfactory, we decided the initial unresectable scenario to perform surgical therapy. After portal vein embolization, right hepatectomy, resection of the extrahepatic bile duct, partial duodenectomy, and partial colectomy were performed. Operative time was 555 min, and intraoperative blood loss was 1654 mL. Pathologic diagnosis of residual gallbladder carcinoma with peritoneal dissemination was confirmed, and the surgical margins were tumour-free. The patient was discharged on postoperative day 29, with a Clavien-Dindo IIIa complication (abdominal wall abscess). Postoperative adjuvant chemotherapy with tegafur/gimeracil/oteracil was administered during 1 year after surgery. The patient is doing well 6 years after the second surgery without evidence of disease.ConclusionsAlthough specific clinical factors were associated with a favourable outcome in this patient, the present report suggests that multidisciplinary therapy may be a promising option in selected patients with distant metastatic GBC.

Prophylactic Hyperthermic Intraperitoneal Chemotherapy for Patients at High Risk of Developing Gallbladder Cancer Peritoneal Metastases: Case Report and Rationale for a Prospective Clinical Trial

“…These results imply that decreasing the overall tumor burden by removing the primary tumor, even with unresected metastatic lesions, there is an associated survival benefit. Although this study did not report the proportion of patients who exhibited peritoneal dissemination, there are also several case reports showing CRS as part of a multimodal approach to patients with pathologically confirmed peritoneal metastasis who survived > 5 years [38,39]. In a multi-institutional investigation, completeness of cytoreduction scores of CC-0 or CC-1 (HR, 24.222; 95% CI, 2.008 to 5.5054; p < 0.001) was a prognostic factor for improved survival on multivariate analysis [40].…”

Iatrogenic bile duct injury: a stitch in time

“…Gallbladder stones are a common clinical condition occurring in the general population, women more than men, while most patients are asymptomatic, a small percentage of them develop gallstones related complications, and among them, a few develop serious complications (approximately 6%). 9 Iatrogenic bile duct injury remains an important complication of cholecystectomy, one of the most performed surgeries in the world. 10 Injury to bile duct can lead to biliary peritonitis, hepatic failure and death.…”

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

“…In general, the prognosis of advanced stage of gallbladder cancer is dismal, but some specific patients group seems to benefit from multidisciplinary aggressive surgical treatment [ 14 , 15 ]. In addition, long-term survival in radically resected patients with limited carcinomatosis of gallbladder cancer was reported [ 16 ].…”