Abstract
A 69-year-old woman was found in enhanced abdominal computed tomography and magnetic resonance imaging to have a tumor congesting the gallbladder tail and body, a swollen lymph node 20 mm in diameter beside the gallbladder neck and another lymph node 85 mm in diameter posterior to the pancreatic head, showed a disrupted cystic duct and a compressed common bile duct. Angiography showed portal vein irregularity suggestive of swollen lymph node invasion. Based on a diagnosis of advanced gallbladder carcinoma with lymph node metastasis invading the portal vein and the pancreatic head, we conducted surgery, but intraoperative findings showed no portal vein invasion, so we conducted pancreatoduodenectomy, extended cholecystectomy, and common bile duct excision with regional and paraaortic lymphadenectomy. Histopathological examination showed papillary adenocarcinoma, depth ss, with lymph node Nos. 12c and 13a positive and stage III. A pancreatic fistula was identified postoperatively. The woman was discharged on postoperative day 36, is doing well, and shows no signs of recurrence 6 years later.
