Chapter-05 Gallbladder Cancer: The Rationale for Aggressive Resection

BOOK TITLE: Recent Advances in Surgery 33

1. Underwood Tim
Publishing Year
Author Affiliations
1. University of Southampton, UK
Chapter keywords


Gallbladder cancer is an aggressive malignancy and the majority of patients will be unsuitable for curative resection at the time of diagnosis. The greater uptake of laparoscopic cholecystectomy for gallstone disease has increased the likelihood of discovering gallbladder cancer incidentally and possibly at an earlier stage. Improvements in mortality and morbidity rates following major hepatobiliary procedures have meant that patients that would formerly have been assessed as unsuitable for radical resection have been offered a potential cure. The initial enthusiasm for radical resection for gallbladder cancer in Japan has been repeated in several centers in North America and Europe. The results of retrospective series from these institutions over the last 15 years are encouraging. Despite the lack of randomized controlled trials (due to the rarity of the disease) we can be confident that surgery offers the only possibility of cure for gallbladder cancer. Surgery offers the only possibility of cure for gallbladder cancer. Cholecystectomy alone is curative in 95% of patients with Tis and T1a disease. Radical surgery improves median survival from 17 to 49 months in suitable patients. Muscle invasion is associated with poor outcome and patients suffering with T1b disease should be considered for radical resection. Radical surgery should take place in a specialist center either as the primary operation or as a delayed procedure following cholecystectomy at another hospital. Referral to a specialist center following the diagnosis of incidental gallbladder cancer is not associated with worse outcome. R0 resection with lymphadenectomy improves survival. Routine resection of the extra-hepatic biliary tree is not supported by current evidence.

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