Evolving treatment strategies for gallbladder cancer
Hueman MT et al. - In a review of evolving treatment strategies for gallbladder cancer, it seems that although data for adjuvant therapy following resection are limited, some data do suggest a survival benefit for adjuvant chemoradiation therapy. Management of pts with gallbladder cancer requires a multidisciplinary approach with input from a surgeon skilled in hepatobiliary surgery. Methods- In the era of laparoscopic cholecystectomy, incidental gallbladder cancer has dramatically increased and now constitutes the major way pts present with gallbladder cancer.
- While pts with incidental gallbladder cancer have a better survival than pts with nonincidental gallbladder cancer, incidental gallbladder cancer can be associated with a varied prognosis.
- Imaging with computed tomography (CT), magnetic resonance imaging (MRI), and [18]F-fluorodeoxyglucose (FDG) positron emission tomography (PET), as well as diagnostic laparoscopy, all have varying roles in the workup of pts with incidental gallbladder cancer.
- For pts with T1b, T2, and T3 incidental gallbladder cancer, re-resection is generally recommended.
Results- At re-exploration, many pts with incidental gallbladder cancer will have residual disease.
- Definitive oncologic management requires re-resection of the liver, portal lymphadenectomy, and attention to the common bile duct.
- Extent of hepatic resection should be dictated by the ability to achieve a microscopically negative (R0) margin.
- Routine resection of the common bile duct is unnecessary but should be undertaken in the setting of a positive cystic duct margin.
- If an incidental gallbladder cancer is discovered at the time of surgery, whether the surgeon should directly proceed with a more definitive oncologic operation should depend on the surgeon’s skill-set and experience.
- Gallbladder cancer has a propensity to recur.
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