Biliary: incidental gallbladder carcinoma: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Biliary: incidental gallbladder carcinoma

Sample item

After routine laparoscopic cholecystectomy for stones in a 58-year-old woman in the Gangetic belt, histology shows adenocarcinoma invading the perimuscular connective tissue (T2) with negative cystic duct margin. Staging CT shows no distant disease. What is the most appropriate next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Re-resection with segment IVb and V liver wedge and portal lymphadenectomy

Incidental gallbladder cancer that invades beyond the lamina propria (T1b or higher) needs radical re-resection: liver resection of segments IVb and V and regional lymphadenectomy of the hepatoduodenal ligament, with excision of port sites where indicated. Simple cholecystectomy is sufficient only for T1a disease. Gallbladder cancer is common in the Gangetic belt and is linked to chronic gallstones and Salmonella typhi carriage.

Option by option

  • A. Observation with serial CA 19-9 only

    Surveillance alone leaves residual disease in the liver bed and nodes untreated.

  • B. Re-resection with segment IVb and V liver wedge and portal lymphadenectomy (correct)

    Correct. T2 disease needs radical re-resection with lymph node clearance to improve survival.

  • C. No further treatment because the gallbladder has been removed

    A simple cholecystectomy is curative only for tumours confined to the lamina propria (T1a).

  • D. Whipple procedure

    Pancreaticoduodenectomy is not a standard operation for T2 gallbladder cancer without head involvement.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Re-resection with segment IVb and V liver wedge and portal lymphadenectomy. Incidental gallbladder cancer that invades beyond the lamina propria (T1b or higher) needs radical re-resection: liver resection of segments IVb and V and regional lymphadenectomy of the hepatoduodenal ligament, with excision of port sites where indicated.

Why is "Observation with serial CA 19-9 only" not the answer?

Surveillance alone leaves residual disease in the liver bed and nodes untreated.

Why is "No further treatment because the gallbladder has been removed" not the answer?

A simple cholecystectomy is curative only for tumours confined to the lamina propria (T1a).

Why is "Whipple procedure" not the answer?

Pancreaticoduodenectomy is not a standard operation for T2 gallbladder cancer without head involvement.

What concept does this question test?

It tests Biliary: incidental gallbladder carcinoma in General Surgery. Simple cholecystectomy is sufficient only for T1a disease. Gallbladder cancer is common in the Gangetic belt and is linked to chronic gallstones and Salmonella typhi carriage.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Biliary: incidental gallbladder carcinoma?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.