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Operative approach to gallbladder cancer

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Abstract

In most Western countries gallbladder cancer is a rare tumor with a poor prognosis. The majority of patients present with advanced-stage tumors (stage IV) that are not amenable to surgical resection. At the other end of the spectrum a small percentage of patients present with stage I disease that may be cured by cholecystectomy. The role for surgery in patients with stage II and III disease remains controversial, but most hepatobiliary surgeons believe that an aggressive surgical approach improves survival for these patients. However, the extent of hepatic and lymph node resection, the need for resection of the extrahepatic ducts in nonjaundiced patients, the role of vascular resection, and the advisability of hepatopancreatoduodenectomy remain a matter of debate. Although no data from prospective, randomized studies are available, resection of the gallbladder and adjacent liver with or without the extrahepatic bile ducts and with a regional lymph node dissection is the operative approach recommended for selected patients with gallbladder cancer.

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References and Recommended Reading

  1. Piehler JM, Crichlow RW: Primary carcinoma of the gallbladder. Surg Gynecol Obstet 1978, 147:929–942.

    PubMed  CAS  Google Scholar 

  2. Cubertafond P, Gainant A, Cucchiaro G: Surgical treatment of 724 carcinomas of the gallbladder: results of the French Surgical Association Survey. Ann Surg 1994, 219:275–280.

    Article  PubMed  CAS  Google Scholar 

  3. Wilkinson DS: Carcinoma of the gall-bladder: An experience and review of the literature. Aust N Z J Surg 1995, 65:724–727.

    PubMed  CAS  Google Scholar 

  4. Choti MA, Bowman HM, Pitt HA, et al.: Should hepatic resections be performed at high volume referral centers? Gastroenterology 1997, 112:1435.

    Article  Google Scholar 

  5. Jarnagin WR, Gonen M, Fong Y, et al.: Improvement in perioperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decade. Ann Surg 2002, 236:397–406.

    Article  PubMed  Google Scholar 

  6. Shirai Y, Yoshida K, Tsukada K, et al.: Radical surgery for gallbladder carcinoma: Long-term results. Ann Surg 1992, 216:565–568.

    Article  PubMed  CAS  Google Scholar 

  7. Todoroki T, Kawamoto T, Takahashi H, et al.: Treatment of gallbladder cancer by radical resection. Br J Surg 1999, 86:622–627.

    Article  PubMed  CAS  Google Scholar 

  8. Kondo S, Nimura Y, Hayakawa N, et al.: Extensive surgery for carcinoma of the gallbladder. Br J Surg 2002, 89:179–184.

    PubMed  CAS  Google Scholar 

  9. Bartlett DL, Fong Y, Fortner JG, et al.: Long-term results after resection for gallbladder cancer: Implications for staging and management. Ann Surg 1996, 224:639–646. This paper describes a revised clinical staging system that is more predictive of outcome and helps in directing surgical management.

    Article  PubMed  CAS  Google Scholar 

  10. Fong Y, Jarnagin W, Blumgart LH: Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 2000, 232:557–569.

    Article  PubMed  CAS  Google Scholar 

  11. Shoup M, Fong Y: Surgical indications and extent of resection in gallbladder cancer. Surg Oncol Clin North Am 2002, 11:985–994.

    Article  Google Scholar 

  12. Dixon E, Vollmer CM, Sahajpal A, et al.: An aggressive surgical approach leads to improved survival in patient with gallbladder cancer: a 12-year study at a North American center. Ann Surg 2005, 241:385–394. This paper demonstrates a marked improvement in outcome of patients with gallbladder cancer over the past 6 years, primarily due to a shift toward more aggressive surgery.

    Article  PubMed  Google Scholar 

  13. Shih SP, Schulick RD, Cameron JL, et al.: Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2006, in press.

  14. Pitt HA, Grochow LB, Abrams RA: Cancers of the biliary tree. In Cancer: Principles and Practice of Oncology. Edited by DeVita VT, Hellman S, Rosenberg SA. Philadelphia: Lippincott-Raven; 1997:114–127.

    Google Scholar 

  15. Nicholl M, Pitt HA, Wolf P, Cooney J, et al.: Choledochal cysts in Western adults: Complexities compared to children. J Gastrointest Surg 2004, 8:245–252.

    Article  PubMed  Google Scholar 

  16. Tanaka K, Nishimura A, Yamada K, et al.: Cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilation. Br J Surg 1993, 80:622–624.

    Article  PubMed  CAS  Google Scholar 

  17. Pitt HA, Dooley WC, Yeo CJ, et al.: Malignancies of the biliary tree. Curr Probl Surg 1995, 32:1–90. A review of the epidemiology, risk factors, staging, and management of biliary malignancies.

    Article  PubMed  CAS  Google Scholar 

  18. Nakeeb A, Tran KQ, Black MJ, et al.: Improved survival in resected biliary malignancies. Surgery 2002, 132:554–564. Retrospective study showing a significant increase in survival in patients with gallbladder and bile duct cancers with aggressive surgical resection and adjuvant chemoradiotherapy.

    Article  Google Scholar 

  19. Fong Y, Malhotra S: Gallbladder cancer: Recent advances and current guidelines for surgical therapy. Adv Surg 2001, 35:1–20.

    PubMed  CAS  Google Scholar 

  20. Vollmer CM, Drebin JA, Middleton WD, et al.: Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies. Ann Surg 2002, 235:1–7. This paper demonstrates the importance of staging laparoscopy in the management of gallbladder cancer.

    Article  PubMed  Google Scholar 

  21. Weber JC, Navarra G, Jiao LR, et al.: New technique for liver resection using heat coagulative necrosis. Ann Surg 2002, 236:560–563.

    Article  PubMed  Google Scholar 

  22. Nakeeb A, Pitt HA: The role of preoperative biliary decompression in obstructive jaundice. Hepatogastroenterology 1995, 42:332–237.

    PubMed  CAS  Google Scholar 

  23. Kondo S, Nimura Y, Kamiya J, et al.: Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg 2002, 387:222–228.

    Article  PubMed  Google Scholar 

  24. Kondo S, Nimura Y, Hayakawa N, et al.: Regional and paraaortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg 2000, 87:418–422.

    Article  PubMed  CAS  Google Scholar 

  25. Pitt HA: Gallbladder cancer: What is an aggressive approach? Ann Surg 2005, 241:395–396.

    Article  PubMed  Google Scholar 

  26. Shimizu Y, Ohtsuka M, Ito H, et al.: Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2004, 136:1012–1017.

    Article  PubMed  Google Scholar 

  27. Kondo S, Nimura Y, Kamiya J, et al.: Five-year survivors after aggressive surgery for stage IV gallbladder cancer. J Hepatobiliary Pancreat Surg 2001, 8:511–517.

    Article  PubMed  CAS  Google Scholar 

  28. Todoroki T, Takahashi H, Koike N, et al.: Outcomes of aggressive treatment of stage IV gallbladder cancer and predictors of survival. Hepatogastroenterology 1999, 46:2114–2121.

    PubMed  CAS  Google Scholar 

  29. Doty JR, Cameron JL, Yeo CH, et al.: Cholecystectomy, liver resection, and pylorus-preserving pancreaticoduodenectomy for gallbladder cancer: report of five cases. J Gastrointest Surg 2002, 6:776–780.

    Article  PubMed  Google Scholar 

  30. Tsukada K, Yoshida K, Aono T, et al.: Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg 1994, 84:108–110.

    Article  Google Scholar 

  31. Shirai Y, Ohtani T, Tsukada K, et al.: Pancreaticoduodenectomy for gallbladder cancer with peripancreatic nodule metastases. Hepatogastroenterology 1997, 44:376–377.

    PubMed  CAS  Google Scholar 

  32. Shirai Y, Ohtani T, Tsukada K, et al.: Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long term results. Cancer 1997, 80:1904–1909.

    Article  PubMed  CAS  Google Scholar 

  33. Pitt HA: Gallbladder and biliary tract. In Atlas of Surgery, vol 1. Edited by Cameron JL. Toronto/Philadelphia: BC Decker; 1990:147–149.

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Indiana University, 535 Barnhill Drive, RT 130D, 46202, Indianapolis, IN, USA

    Henry A. Pitt MD

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  1. Henry A. Pitt MD
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  2. Attila Nakeeb MD
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Correspondence to Henry A. Pitt MD.

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Pitt, H.A., Nakeeb, A. Operative approach to gallbladder cancer. Curr Gastroenterol Rep 8, 161–167 (2006). https://doi.org/10.1007/s11894-006-0013-9

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  • DOI: https://doi.org/10.1007/s11894-006-0013-9

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