Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 881 - файл

Radical surgical resection, with negative margins, is the only potentially curative treatment; it consists in cholecystectomy, unless the patient has already undergone cholecystectomy with occasional nding at pathologic review, associated to liver resection of segments IVb and V and locoregional lymphadenectomy, including cystic node (Mascagni’s node) and those of hepatic hilum; common bile duct resec­tion is not recommended tout court but only to achieve radical resection with mar­gins free of disease [15]; it can be useful to obtain an intraoperative frozen section of cystic duct stump to decide the need for further resections. Diagnostic laparos­copy avoids a nontherapeutic laparotomy in about 56% with unrespectable disease, and it demonstrates a higher yield primarily in locally advanced tumors than in early-stage tumors where disseminated peritoneal disease is quite rare [16]. A debated issue was the indication to remove the port site after laparoscopic cholecys­tectomy with successive incidental nding of GBG; this has not been shown to change outcomes, since these types of spreads were found in patients with advanced disease and correlates with peritoneal metastasis [17].