A novel approach to gallbladder cancer in a Jehovah's Witness.
Transfusion of blood or blood products peri- or postoperatively is often necessary in patients undergoing liver resections for hepatic or biliary tract neoplasms. In Jehovah's Witnesses this inevitably poses a difficult dilemma for clinicians. A 66-year-old female Jehovah's Witness with a T1b gallbladder cancer was referred to our specialist unit for further treatment after having had a routine laparoscopic cholecystectomy in another hospital. Although an abdominal computed tomography scan preoperatively showed a normal liver with no evidence of regional lymph node involvement, histologically the tumor was found in the posterior wall of the gallbladder adherent to the liver bed and had a full thickness involvement of the muscular layer, raising suspicion of a local invasion into the liver bed. The patient, having refused liver resection, was treated with a laparoscopic radiofrequency ablation under intraoperative ultrasound guidance using a newly developed "cooled-tip" needle and a 500-kHz radiofrequency generator. A "zone of necrosis" measuring 3.5 cm in diameter was created in the liver bed and adjacent tissues. The procedure lasted 90 min with no blood loss. Postoperatively, the patient was discharged on the third postoperative day and remained disease free at the 9-month follow-up. Although the follow-up in this case was too short to determine the long-term result of this approach, we believe that this is a single unique case posing a challenging problem to clinicians for which radiofrequency ablation may have a role in offering an alternative to major resections.
Navarra
G
G
Department of Surgical Oncology and Technology, Imperial College School of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, United Kingdom.
Jiao
L R
LR
Weber
J C
JC
Nicholls
J P
JP
Jensen
S L
SL
Habib
N A
NA
D000368:Aged; D001803:Blood Transfusion; D017115:Catheter Ablation / Q000379:methods*; D002835:Christianity; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D012068:Religion and Medicine; D016312:Treatment Refusal