Peep Before You Enter – Laparoscopy in Gall Bladder Cancer

Gall bladder cancer (GBC) is the commonest biliary tract cancer worldwide. Clinically ‘obvious’ GBC is usually advanced; a careful search should be made for metastases. In the absence of clinical metastases, resectability should be assessed with CT; PET can complement CT in detecting metastases. Laparoscopy has been used for staging of pancreatic and hepato-biliary cancers. Staging laparoscopy is ‘strongly recommended’ before laparotomy in GBC; it should be performed in incidental GBC also before reoperation for completion extended cholecystectomy (CEC). Addition of US to laparoscopy can increase the yield and accuracy. Laparoscopic extended cholecystectomy has also been reported. We have described anticipatory extended cholecystectomy (AEC) for thick walled GB; it can also be performed laparoscopically.