Treatment of Resectable Gallbladder Cancer

Abstract

Gallbladder cancer (GBC) is the most common biliary tract cancer worldwide and its incidence has significant geographic variation. A unique combination of predisposing factors includes genetic predisposition, geographic distribution, female gender, chronic inflammation, and congenital developmental abnormalities. Today, incidental GBC is the most common presentation of resectable gallbladder cancer, and surgery (minimally invasive or open) remains the only curative treatment available. Encouragingly, there is an important emerging role for systemic treatment for patients who have R1 resection or present with stage III-IV. In this article, we describe the pathogenesis, surgical and systemic treatment, and prognosis.

Keywords: gallbladder cancer; incidental; oncologic extended resection; resectable; treatment.

Figure 1

Gallbladder cancer (GBC) Histology: (A) GBC, biliary type, infiltrating gallbladder (GB) wall. The top of the image shows normal GB mucosa, H&E stain, ×40; (B) gallbladder carcinoma invading muscularis propria, H&E stain, ×100; (C) perineural invasion, H&E stain, ×100; (D): Metastatic high-grade GBC to lymph node, H&E stains, G- ×100, H- ×400.

Figure 2

Key prognostic information in incidental gallbladder cancer (IGBC) available after the index cholecystectomy. A study of 10-year period review found that from 435 GBC patients, 391 (90%) had adenocarcinomas. Additional histologies were squamous/adenosarcoma (1.6%) and unspecified (1.1%) [34].

Figure 3

Oncologic extended resection (OER) should include sampling of aortocaval lymph nodes, specifically station 16b1; dissection of the hepatoduodenal ligament (station 12), common hepatic artery (station 8), and retropancreatic lymph nodes (station 13); limited resection of the liver bed or anatomic resection of liver segments IVb and V or rarely major liver resection.

Figure 4

Operating room set-up and scheme of port positioning in laparoscopic OER. IOUS, intraoperative ultrasound.