with Dr. Sara Nogueira
Gallbladder cancer is the most common biliary tract malignancy.
It is often discovered incidentally during or after a cholecystectomy performed for a presumed benign disease. When symptomatic, we are usually dealing with a disseminated disease that spreads through 3 routes: lymphatic, hematogenous and peritoneal.
The global incidence of gallbladder cancer varies according to geographic region and racial group. Women are affected two to four times more often than men.
It is usually a disease of the elderly, with most cases being diagnosed after the age of 60. Even in the presence of a resectable disease, overall 5-year survival is only 20%.
The most consistent risk factor associated with gallbladder cancer is cholelithiasis and chronic inflammation. Many studies have been published in this field, trying to understand the cause-effect mechanism linking these two entities and many significant connections have been found, but not enough to consider cholelithiasis as the only risk factor.
Gallbladder cancer can be found in about 0.2% to 2% of patients when a simple cholecystectomy is performed, in the setting of a presumed benign disease.
The diagnosis can be intraoperative or postoperative.
When a diagnosis of gallbladder cancer is made, the surgeon may opt for either one of two pathways, depending on their experience and that of the center:
1.- Prepare for a curative resection with a possible liver and portal lymph node dissection.
2.- If not an experienced HBP surgeon, end the procedure and transfer the patient to a specialized facility. Either option does not appear to affect outcomes.
Incidental diagnosis of gallbladder cancer can also be done postoperatively, during the pathological analysis of the cholecystectomy specimen.
In this case, a final pathological stage is given and the patient can be examined and treated accordingly.
Surgery is the only curative treatment for patients with gallbladder cancer.
The extent of resection depends first on the staging of the disease; the location of the tumor; the negativity of the margins if a previous cholecystectomy was performed and on whether the cholecystectomy was curative. Adjuvant and neoadjuvant treatment can be useful in patients with node positive and/or >=T2 disease.
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