Treatment of Gallbladder Adenoma ≥20 mm with No Preoperative Evidence of Malignancy
A gallbladder adenoma reaching 20 mm or more presents a distinct surgical management challenge — even when preoperative workup reveals no evidence or indication of malignancy, the size threshold carries important implications for how the resection should be planned and performed.
Clinical Scenario
A gallbladder adenoma ≥20 mm in size is present. There is no preoperative evidence or indication of malignancy. Because of the strong possibility of malignant transformation associated with adenomas of this size, the surgical approach must be planned accordingly — regardless of the benign preoperative appearance.
Surgical Approach (partial overview)
Management involves open surgery performed by a surgeon with experience in hepatobiliary procedures, following a surgical plan modelled on the approach used for gallbladder carcinoma. Laparoscopic cholecystectomy is specifically not recommended for this presentation. The full operative strategy and intraoperative decision framework are detailed in the structured protocol.
Full resection plan, margin considerations, and surgical decision points available in the complete protocol →
References
DOI: 10.4240/wjgs.v16.i6.1507
However, if a gallbladder adenoma ≥ 20 mm in size exists, a surgical plan similar to that of gallbladder carcinoma will be drawn up, as long as there are not any preoperative evidence or even an indication of malignancy.
Laparoscopic cholecystectomy is not recommended for such patients since there is a strong possibility of malignant transformation.
Thus, an open surgery should preferably be carried out by a surgeon experienced in hepatobiliary surgery, who should keep in mind the following cancer management strategy.
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