Gallbladder Cancer

T1a GB Ca: usually early stage

- usually found incidentally after routine lap chole

- incidence after routine lap chole for cholelithiasis - 1-2%

- 5 year survival for T1a GB ca confined to the mucosa - 85-100%

Symptomatic patients: usually advanced stage

- U/S only 50% sensitive for GB ca

- if suspicion of GB cancer pt should have a CT scan or MRI to look for invasion into adjacent structures, LN or encasement of portal vein or hepatic artery.

- Other investigations to consider: PET, MRCP, ERCP

Treatment is based T-stage of the tumor

- contraindications to surgical resection: liver mets, malignant ascites, peritoneal mets, distant disease, extensive involvement of hepatoduodenal ligament, encasement or occlusion of major vessels, poor performance status.

Lap Chole:

Tis or T1a

Radical Cholecystectomy:

-T1b (15% subserosal LN involvement) or T2 (40-80% subserosal LN involvement)

- radical cholecystectomy involves resection of GB with a 2cm hepatic parenchymal margin and LN dissection within the porta hepatis, gastroduodenal ligament, gastrohepatic ligament and Kocher for LN dissection behind duodenum
- can be done at time of initial lap chole or can be delayed - survival the same

Radical Cholecystectomy +/- en bloc resection of locally invaded organs:

- advised for T3/T4 tumors only if there is no evidence of metastatic spread

- 25-44% 5 year survival rate

Palliation:
- survival in locally unresectable or metastative disease often <1 yr
- no effective adjuvant treatment - all part of clinical trials