From the Guidelines
The management of intracholecystic papillary neoplasm (ICPN) of the gallbladder primarily involves surgical resection with cholecystectomy as the standard treatment. This approach is based on the principle that surgery remains the only curative modality for gallbladder cancer, as stated in the NCCN clinical practice guidelines in oncology: hepatobiliary cancers 1.
Key Considerations
- The surgical approach for patients found to have resectable gallbladder cancer is the same, provided the gallbladder was not removed, and should be performed by a surgeon prepared to do a cancer operation 1.
- Factors determining gallbladder tumor resectability include the stage of the tumor according to AJCC TNM staging criteria and tumor location, with staging laparoscopy recommended before laparotomy for a potentially curative resection of gallbladder cancer 1.
- For cases with invasion beyond the muscular layer or with high-grade dysplasia, a more extensive radical cholecystectomy with regional lymph node dissection is recommended, including removal of segments IVb and V of the liver along with portal lymphadenectomy.
Preoperative and Intraoperative Evaluation
- Preoperative evaluation should include imaging studies such as ultrasound, CT, or MRI to assess the extent of disease and potential invasion.
- During surgery, frozen section analysis may be performed to determine the extent of invasion and guide the surgical approach.
Prognosis and Follow-Up
- The prognosis for ICPN is generally favorable when detected early without invasion, with 5-year survival rates exceeding 90%.
- However, invasive ICPNs have a worse prognosis, similar to conventional gallbladder adenocarcinoma.
- Regular follow-up with imaging is recommended after surgery, particularly for invasive cases, though no standardized surveillance protocol exists.
From the Research
Management of Intracholecytic Papillary Neoplasm of Gallbladder
- The management of intracholecytic papillary neoplasm (ICPN) of the gallbladder is primarily surgical, with laparoscopic cholecystectomy being the recommended treatment 2, 3.
- In cases where the ICPN is diagnosed incidentally after cholecystectomy, clinical follow-up is recommended without additional surgical intervention, with a 5-year prognosis of 90% survival 2.
- Pathological examination of the lesion is crucial in determining the management and prognosis of ICPN, as it can help identify key features such as high-grade dysplasia and stromal invasion 4, 5.
- The classification of ICPN into different subtypes, such as gastric, intestinal, biliary, and oncocytic, can also influence management and prognosis, with some subtypes having a higher risk of concurrent adenocarcinoma 5.
- In general, ICPN is considered a premalignant lesion, and early diagnosis and treatment are essential to prevent progression to invasive carcinoma 6.
- The prognosis of invasive carcinoma arising from ICPN is better than that of de novo gallbladder carcinomas, highlighting the importance of early detection and treatment 6.