Saturday, May 21, 2011

When to Excise CBD (Common Bile Duct) in cancer of gallbladder


Indications for the resection of the EHBD in all stages of disease include —
1.Tumors involving the EHBD  Preoperatively indicated by the presence of obstructive jaundice, in the absence of distant metastasis

2. Tumors/gross lymph nodal enlargement close to or involving the common hepatic duct or hilum

3.  Inflamed or a fatty hepatoduodenal ligament rendering nodal dissection difficult

4. Patients ndergoing re-resection (since postoperative inflammation makes differentiation of tumor and scar difficult).

5.Positive cystic duct margin on intraoperative frozen section

6.Patients with associated APBDJ or choledochal cyst— these patients are at an increased risk of further metachronous malignancies of the biliary tree and should hence undergo EHBD resection at the time of treatment of the gallbladder cancer

In case of need for associated vascular resection/ reconstruction