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Evolving treatment strategies for gallbladder cancer
Annals of Surgical Oncology, 06/08/09

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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