Sequential laparoscopic and oncological management of choledocholithiasis with incidental gastric cancer: a clinical case a clinical case
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Abstract
The coexistence of choledocholithiasis and gastric cancer is uncommon, especially when the latter is diagnosed incidentally during the management of biliary pathology. We present the case of a 55-year-old woman with obstructive jaundice (right upper quadrant pain, jaundice, dark urine, and pruritus of 15 days' duration). Ultrasound and magnetic resonance cholangiopancreatography (MRCP) confirmed distal choledocholithiasis. During endoscopic retrograde cholangiopancreatography (ERCP), where stone extraction was unsuccessful and a biliary stent was placed for drainage, a 20-mm prepyloric gastric lesion with irregular borders and necrotic areas was incidentally detected. The subsequent biopsy revealed an infiltrating, poorly differentiated (grade 3) intestinal-type gastric adenocarcinoma. The staging CT scan showed a locally advanced neoplasm (cT3-T4, N1-2M0; clinical stage cIIIA–IIIB according to the AJCC 9th edition). Laparoscopic cholecystectomy with choledochotomy and stone extraction was performed, with a favorable postoperative course. The patient is currently being prepared for neoadjuvant chemotherapy with the FLOT regimen, following the request for molecular biomarkers that will guide future treatment options.
This case highlights the successful surgical resolution of complicated choledocholithiasis using laparoscopic choledochotomy. This procedure not only effectively addressed the biliary pathology but also normalized liver function, a critical step to allow the timely and safe initiation of neoadjuvant chemotherapy with FLOT three weeks postoperatively, minimizing the risks of toxicity
and delaying oncological treatment of the gastric cancer.
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