The surgical management of gallbladder cancer

Abstract

Among biliary tract cancers, gallbladder cancer (GBC) is a potentially lethal malignancy with abysmal long-term survival. Surgery is central to the management of GBC, and presently, provides the only ray of hope for long-term survival. Radical cholecystectomy, which includes cholecystectomy with a limited hepatic resection, regional lymphadenectomy and adjacent organ resection if required is used to encompass the tumor with negative margins – R‘0’ resection is the standard surgical treatment for the management of GBC. Absence of randomized controlled trials to address various surgical controversies due to rarity of disease in western world, advanced disease at presentation, high frequency of unresectability/inoperability at surgery, deficient neoadjuvant/adjuvant strategies and nihilistic views of oncologists due to aggressive disease biology has resulted in marked heterogeneity in surgical strategies employed to manage GBC across the surgical centers globally.

Keywords:

• bile duct resection
• gallbladder cancer
• hepatectomy
• jaundice
• lymphadenectomy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• All post-cholecystectomy gallbladder specimens should be opened and examined carefully by the operating surgeon; they must always be sent for histopathological examination.

• Radical surgery for gallbladder cancer (GBC) should address GB fossa and lymph nodes; the aim of surgery in GBC is to achieve R‘0’ resection.

• Systematic lymphadenectomy is central to the goal of achieving a good oncologic outcome. N1 and N2 nodal stations must be dissected thoroughly.

• Bile duct resection should be undertaken in selected situation, and its involvement should not preclude resection.

• Adjacent organ resection should be undertaken only if R‘0’ resection can be achieved with safety.

• Further improvement in outcome would be with integration of multimodal approach.

• There is urgent need for multicentric randomized clinical trials to generate level I evidence for standardization of management of GBC.

Notes