Practical Guidelines for the Surgical Treatment of Gallbladder Cancer

Practical Guidelines for the Surgical Treatment of Gallbladder Cancer

At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Manyefforts therefore have been made to improve resectability and the survival rate. However,GB cancer has a low incidence, and no randomized, controlled trials have been conductedto establish the optimal treatment modalities. The present guidelines include recentrecommendations based on current understanding and highlight controversial issues thatrequire further research. For T1a GB cancer, the optimal treatment modality is simplecholecystectomy, which can be carried out as either a laparotomy or a laparoscopicsurgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer atstage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or asegmentectomy IVb/V can be performed and the optimal extent of lymph node dissectionshould include the cystic duct lymph node, the common bile duct lymph node, the lymphnodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymphnodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patientstatus and disease severity, surgeons may decide to perform palliative surgeries.

At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Manyefforts therefore have been made to improve resectability and the survival rate. However,GB cancer has a low incidence, and no randomized, controlled trials have been conductedto establish the optimal treatment modalities. The present guidelines include recentrecommendations based on current understanding and highlight controversial issues thatrequire further research. For T1a GB cancer, the optimal treatment modality is simplecholecystectomy, which can be carried out as either a laparotomy or a laparoscopicsurgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer atstage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or asegmentectomy IVb/V can be performed and the optimal extent of lymph node dissectionshould include the cystic duct lymph node, the common bile duct lymph node, the lymphnodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymphnodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patientstatus and disease severity, surgeons may decide to perform palliative surgeries.