Gallbladder cancer: Can newer insights improve the outcome?

Abstract

Gallbladder cancer (GBC) is the leading cause of cancer related mortality in certain geographic areas. Most of the patients with GBC have advanced disease at presentation, precluding curative resection resulting in a dismal prognosis. However, recent advances in the understanding of its epidemiology and pathogenesis coupled with development of newer diagnostic tools and therapeutic options, has resulted in enhanced optimism towards the management of the disease. The leading risk factors are gallstones, advancing age, female gender, anomalous pancreaticobiliary ductal junction, certain ethnic groups and geographic populations. Advances in radiological imaging and the advent of endoscopic ultrasound have facilitated early detection and accurate staging of the tumor. A high index of suspicion in high risk groups is necessary to pick up incidental and early GBC, as surgical resection is curative. In patients with suspected GBC, an open surgical resection that is appropriate for that stage is advocated. Adjuvant combination chemotherapy and molecular targeted therapy are emerging as effective therapeutic options in those with advanced GBC. Endoscopic palliation of biliary and gastric outlet obstruction with metallic stents has improved their quality of life. Prevention remains the hitherto less explored option to reduce GBC related mortality. Prophylactic cholecystectomy in high risk groups is a cost-effective option. A multi-disciplinary systematic global approach to initiate collaborative ventures to understand epidemiology, standardize management strategies, conduct multi-centric trials with newer therapeutic agents and initiate preventive measures, would pave way for the future conquest of the disease.

Radical Surgery for Incidental Gallbladder Carcinoma. Which Subset of Patients is Really Suitable for?

“…In addition, while patients with in-situ and intramucosal carcinomas are all alive after a mean follow-up of 69 months, T2 and T3 lesions showed, overall, an unsatisfactory prognosis with a median of 19 and 5 months for the two groups, respectively; these findings coincide with those reported by many authors [7,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

“…Furthermore, the frequent occurrence of the gallbladder carcinoma in the seventh and eighth life decade [3] (8 patients in our group are more than 75 years old) could make problematic the indication to a demanding surgical procedure comprising an extended liver resection and nodal dissection, in which are described postoperative complication rates up to 30-40% [8,9], even in the more recent literature [13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Correlative Imaging in Gallbladder Carcinoma

“…Adjuvant combination chemotherapy and molecular targeted therapy are emerging as therapeutic options in those with advanced GBC (19).…”

Simple cholecystectomy versus radical resection for stage Ⅱ gallbladder cancer: a meta-analysis

“…Inoperable GBC or tumors with distant metastasis might profit from adjuvant therapy and the survival time lengthen. 2 Surgical procedures for GBC are mainly as follows: simple cholecystectomy, radical resection, extended radical resection and palliative operation, the selection of which is guided by the progress of tumor. Post-operative survival time of GBC patients is affected by T-stage, lymph node invasion, distant metastasis and jaundice, and at the meantime, tumor recurrence and metastasis may have a correlation with the degree of tumor invasion, the tumor site and histological grade.…”

“…1 It still relies on surgical method to treat and provide the possibilities of favorable prognosis, while auxiliary methods like radiotherapy and chemotherapy are likely to reduce the chance of tumor relapse and improve the longterm survival of GBC patients. 2 GBC patients' survival time -one of the major indicators for prognosis judgment isn't affected by sexuality, age or ABSTRACT Background: GBC was first reported more than two hundred years ago, but the poor therapeutic effect for GBC patients is still frustrating now, the 5-year survival rate is no more than 5%, and the mean survival time is only about half a year. The objective of this study was to evaluate the importance of radical resection in the treatment of Nevin II and T1b stage gallbladder cancer (stage II GBC) by analyzing the survival rate and tumor recurrence rate after accepting simple cholecystectomy (SC) and radical resection (RR).…”