Surgical management of gallbladder cancer

Abstract

Gallbladder cancer is a very common malignancy in the northern part of India. Surgery is the only potentially curative modality of treatment for this disease. Radical cholecystectomy is the optimal surgical standard for resectable gallbladder cancer. This includes cholecystectomy, liver resection (wedge, segments 4b and 5, or extended right hepatectomy), and regional lymphadenectomy along the hepatoduodenal ligament, behind the duodenum and pancreatic head, common hepatic artery and celiac axis. Controversies regarding extent of liver resection, lymphadenectomy and role of multiorgan resection have been discussed. Incidental gallbladder cancer is often detected on histopathologic examination of the simple cholecystectomy specimen removed for a presumed gallstone disease. Revision surgery should be performed for incidental cancers that invade muscularis propria or beyond (T1b or more). Advanced gallbladder cancer should be treated non-operatively with a palliative intent. Obstructive jaundice in the setting of an advanced gallbladder cancer can be palliated with biliary stenting by endoscopic or transhepatic means. Occasionally, a surgical biliary bypass may be indicated to relieve intractable pruritus in a jaundiced patient with gallbladder cancer. There is no role of a planned R2 resection of advanced gallbladder cancer for the purpose of cytoreduction. Further improvement in the management of gallbladder cancer will need integration of systemic chemotherapy with radical surgery.REVIEW ARTICLE

Jaundice After Radical Cholecystectomy and Bile Duct Resection: A Case of Postoperative Acute Viral Hepatitis A Confounding the Clinical Picture

“…While the author does not perform bile duct resection routinely in patients with operable gallbladder cancer, there are circumstances that warrant bile duct resection [2]. This patient had cystic duct margin showing gross tumor and hence resection of bile duct with Roux-en-Y hepaticojejunostomy was a logical choice.…”

“…Radical cholecystectomy is the only curative option for patients with resectable disease. Resection of the common bile duct may be required if the tumor/lymph node is seen to involve the CBD or if the cystic duct margin is positive [2]. Postoperative jaundice in the setting of radical cholecystectomy with CBD resection usually points to stricture of the hepaticojejunostomy or recurrence of the cancer.…”

Survival analysis and prognostic factors of the carcinoma of gallbladder

“…Management of GBC remains a tedious task due to its unclear and unspecific signs and symptoms. Unfortunately, the symptoms of GBC and gallstone disease share a common ground, resulting in the delayed diagnosis, primarily at its advanced stages [ 12 ]. Surgery remains the only potential cure; however, only limited patients diagnosed in their early-stage disease benefit from resection.…”

The Rationality of Resectional Surgery and Palliative Interventions in the Management of Patients with Gallbladder Cancer

“…9 Radical cholecystectomy is the optimal treatment option for resectable gallbladder cancer. 10 This includes cholecystectomy, liver resection (wedge resection, segment IVb + V resection, or extended right hepatectomy), and regional lymphadenectomy along the hepatoduodenal ligament, behind the duodenum and pancreatic head, common hepatic artery, and celiac axis. Although aggressive surgery including vascular and multivisceral resection has been shown to be feasible, morbidity and mortality raises parallel to increase in the resection area and debate continues as to the relative risk-benefits of radical surgery for advanced disease.…”