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Gall bladder

Topic: Gallbladder

Subtopic: Lymph Node Retrieval and Lymphadenectomy in Gallbladder Cancer

Question: Number of minimum nodes to be retrieved in Ca GB?

  • A) 5
  • B) 6
  • C) 7
  • D) 8

Correct Answer: B) 6

Explanation: In the context of gallbladder cancer (Ca GB), proper staging and treatment often require the retrieval of lymph nodes. A minimum of 6 lymph nodes should be retrieved for accurate pathological assessment. This includes different echelons of lymph nodes:

  • First echelon: 12c (cystic) and 12b (pericholedochal)
  • Second echelon: 12a (common hepatic artery), 12p (periportal), and 13a (posterosuperior pancreaticoduodenal)
  • Distant lymph nodes: Aortocaval (16), Celiac (9), Superior Mesenteric Artery (SMA) (14)

The surgical procedure often involves extended cholecystectomy (CCx) which may include a wedge resection of the liver or anatomical segments IVb/V and lymphadenectomy of regional lymph nodes. Routine excision of the common bile duct (CBD) is not recommended unless specific conditions such as a positive cystic duct margin, extensive lymph node involvement, or papillary variant histology are present.

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Subtopic: Risk of Gallbladder Cancer in Gallstone Disease

Question: Annual risk of GB cancer in gallstone disease?

  • A) 0.2%
  • B) 2%
  • C) 0.02%
  • D) 5%

Correct Answer: C) 0.02%

Explanation: Gallstones are present in 60-90% of patients with gallbladder cancer (GBC). However, the overall incidence of developing GBC among those with gallstones is relatively low, ranging from 0.3% to 3%. The annual risk of developing gallbladder cancer from gallstones is approximately 0.02% per year (Blumgart, Page 555).

Risk Factors for Gallbladder Cancer:

  • Symptomatic gallstones
  • Cholesterol stones are more likely to be associated with GBC than pigment stones
  • Large stones (>3 cm) or a gallbladder filled with stones
  • Mirizzi syndrome
  • Xanthogranulomatous cholecystitis
  • Race and ethnicity: Higher prevalence in North India, Chile, Pakistan
  • Age and gender: More common in older individuals and females (F > M)
  • Lifestyle factors: Obesity, diabetes, smoking
  • Chronic infections: Salmonella typhi, Helicobacter pylori
  • Cholecystoenteric fistula
  • Porcelain gallbladder: Especially with stippled calcification (risk ~10%)
  • Low socioeconomic status