Diagnosis and Surgical Management of Gallbladder Cancer: A Review

Abstract

Gallbladder cancer is one of the most lethal carcinomas and continues to pose many challenges for surgeons. Identifiable risk factors for carcinoma of the gallbladder include cholelithiasis, an anomalous pancreaticobiliary junction, and focal mucosal microcalcifications. Adenocarcinoma is the primary histologic type in most patients and the tumor is frequently associated with Kras and p53 mutations. Radiologic and endoscopic advances in endoscopic ultrasonography and magnetic resonance cholangiopancreatogram, plus helical computed tomography, have enhanced preoperative staging. Surgical options include cholecystectomy for disease limited to the mucosa (Tis/T1) or a radical cholecystectomy (subsegmental resection of segments IVB and V plus a hepatoduodenal ligament lymphadenectomy) for advanced disease without signs of distant metastasis (T2-4/N0-N2). Some surgeons have advocated more radical hepatic resection including extended right hepatectomy or central bisegmentectomy plus caudate lobectomy. Japanese surgeons have reported studies that included patients having a pancreaticoduodenectomy to improve distal ductal margins and lymphadenectomy for T3 and T4 cancers. These patients have a lower rate of local recurrence but no survival advantage. Options for adjuvant therapy remain limited. Radiation therapy with fluorouracil radiosensitization is the most commonly used postoperative treatments. Current trials are investigating the role of capecitabine, oxaliplatin, and bevacizumab in the management of gallbladder carcinoma.

Adjuvant chemoradiation therapy in gallbladder cancer

“…However, there is still no established standard regimen of adjuvant chemotherapy for GB cancer [16][17][18][19]. Traditionally, 5-fluorouracil-based chemotherapy regimen has been used as an adjuvant therapy for biliary tract malignancies including GB cancer [6,9,20,21]. Recently, gemcitabine-, capecitabine, or S-1-based regimens have been tried, and several studies have demonstrated somewhat promising results from GB cancer [22][23][24][25][26].…”

Expression of interleukin-6 is associated with epithelial-mesenchymal transition and survival rates in gallbladder cancer

“…The 5 year mortality rate is up to 90% (2), while the median survival prognosis for patients is 4-6 months. Due to the advanced stage at presentation, only a third of patients are potential candidates for surgery (3). GBC is highly invasive and spreads to regional lymph nodes at an early stage.…”

Correlative Imaging in Gallbladder Carcinoma

“…The clinical presentation of GBCA remains unspecific and may include abdominal pain, weight loss, fever, and jaundice (9).…”