Who is Afraid of the Gallbladder? Case Series of Unmitigated Pericholecystic Microwave Ablations of Liver Tumours with Pictorial Review.

PURPOSE: Thermal ablation of liver tumours is widely established. A location in vicinity of the gallbladder (GB) usually causes apprehension. Our intention was to gather data from our day-to-day practice to assess whether pericholecystic tumours can be ablated safely without protective measures.

MATERIALS AND

METHODS

Retrospective review of patient series undergoing microwave ablation of primary and secondary pericholecystic liver tumours (segments IVb-V) without hydro-pneumodissection between September 2018 and September 2025, in which the ablation zone encompassed the GB wall. Outcomes are technical success (> 5 mm safety margins), complication rate, hospital stay length, postoperative pain, modified gastrointestinal symptoms rating scale (mGSRS) score at 24h, rate of 30-day hospital readmission 3-, 6-, 12-month local tumour progression-free survival (LTPFS).

RESULTS

Forty-eight patients were included; 34 (70.8%) were males. Average age was 67 years (SD ± 10.2). Hepatocellular carcinoma was the most common diagnosis. Twenty-six (54.2%) procedures were performed on a single lesion near GB. Technical success was 100%. No severe complications were seen. Average pain score was 1.9 (SD ± 1.8; median 1, IQR 0.75-2.25), and mGSRS score was 8.6 (SD ± 5.8; median 7.5 IQR 4-11); average hospital stay length was 1.9 days (SD ± 2.3; median 1 day; IQR 1-2 days). Four patients (8.3%) required readmission: 1 (2.1%) due to delayed cholecystitis (treated conservatively) and 3 (6.3%) due to pain, but no additional intervention. 3-, 6-, 12-month LTPFS was 94%, 89% and 80%.

CONCLUSION

The incidence of GB injury was low in this series, and the procedures were well tolerated. A protective hydro- or pneumodissection was found to be not essential.